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To promote early contact with cardiology and ensure appropriate monitoring for babies receiving a prenatal diagnosis of an arrhythmia
This guideline is for neonatologists and paediatric cardiology teams, caring for babies with a prenatal diagnosis of a fetal arrhythmia.
Fetal arrhythmias are uncommon and the incidence of structural cardiac abnormalities in fetuses with irregular heart rhythms is low (<2%). Ectopic beats are estimated to be present in around 1% of unselected pregnancies and in the majority of cases will resolve before delivery.
Fetal tachycardia can result in significant morbidity and mortality if left untreated in utero. The ideal management is to treat the tachycardia prior to delivery so that the fetus is delivered in a non-hydropic state, at term, without evidence of tachycardia. Prenatal therapy is guided by the fetal cardiology and fetal medicine team jointly and in our institution 1st line maternal therapy is flecainide, with the addition of digoxin in resistant tachycardias as a second line therapy. Therapy is carefully considered, implemented and monitored due to the potential adverse effects to the mother and fetus.
Some patients may have been recruited as part of the international FAST trial (Fetal atrial flutter and supraventricular tachycardia trial). This study aims to compare the impact of different prenatal treatment strategies from the time of diagnosis of fetal supraventricular tachyarrythmia (SVT) to 30 days after birth. Maternal therapy will include a combination of digoxin, flecainide or sotolol, determined by trial randomisation or families may wish to be placed upon the registry, following normal institutional management.
a) If extrasystoles persist after birth
b) If extra-systoles have resolved prior to birth
a) Failure to cardiovert medically during fetal life
b) Successful medical cardioversion during fetal life
Last reviewed: 01 May 2020
Next review: 31 May 2022
Author(s): Dr Lindsey Hunter; Dr Karen McLeod; Lorraine Mulholland; Kathleen O’Reilly
Approved By: Paediatric Cardiology & Neonatology
Reviewer Name(s): A Powls; M Worrall; G Bell