EP04.11: Transplacental treatment of fetal supraventricular tachycardia with a combination of sotalol and flecainide

Fetal supraventricular tachycardia is the most common form of fetal tachycardia. When it causes signs of hemodynamic compromise, fetal distress, or hydrops fetalis, immediate medical therapy should be undertaken. Digoxin is often used as first-line therapy but can be ineffective and is poorly transferred to the fetus in the presence of fetal hydrops. In this case, an additional antiarrhythmic drug should be tried. A 27 year old women was transferred to our hospital for fetal supraventricular tachycardia at 25 weeks of gestation. Fetal cardiac sonography revealed supraventricular tachycardia with heart rate of 230–250 bpm and fetal hydrops. Despite digoxin, fetal tachycardia was persistent. So the combination therapy of transplacental sotalol and flecainide was done. Conversion to sinus rhythm was followed this treatment and the hydroptic sign gradually disappeared without any significant sequelae. For fetus with fetal tachycardia combined with hydrops, a combination therapy of sotalol and flecainide is effective and tolerable treatment.