Successful Treatment of Fetal Atrial Flutter with Sotalol in a Non-hydrops Fetalis

Üçüncü trimesterde atrial flatter tespit edilen, önce digoksin ile tedavi edilen, sonra digoksini tolere edemeyan hastada sotalol ile başarı ile tedavi ettiğimiz bir hastayı sunduk. Yirmi altı yaşında primigravid olan hasta, gebeliğinin 32. haftasında fetal taşikardi ön tanısıyla kliniğimize gönderildi. Yapılan fetal ekokardiografide (EKG) atrial hız 533 vuru/dak ve ventriküler hız 266 vuru/dak tespit edildi ve fetal atrial flatter tanısı konuldu. İlk olarak digoksin ile tedavi edilen hastada, digoksine bağlı kusma, mide bulantısı, hipotansiyon, epigastrik ağrı ve EKG'de değişiklikler olması üzerine digoksin tedavisi kesildi. Digoksini tolere edemeyen hastada sotalol ile tedaviye devam edildi. Sotalol tedavisinden sonra fetal kalp hızının azaldığı ve sinüs ritmine döndüğü görüldü. Gebelik terme kadar sağlıklı bir şekilde devam ettirildi ve vajinal doğumla 1.dakika Apgar skoru 9, 5. dakika Apgar skoru 10 olan bir adet 2800 gram erkek bebek doğurtuldu. Yenidoğanın ekokardiografisinde yapısal bir anomali tespit edilmedi. Fetal ekokardiografi fetal taşiaritmilerin tanısında ve takibinde güvenilir bir yöntemdir. Digoksin fetal aritmilerin tedavisinde ilk seçenek ajandır ancak terapötik düzeylerde digoksini tolere edemeyen ve digoksine baglı yan etkileri çıkan hastalarda ikinci seçenek ajanlara ihtiyaç duyulmaktadır. Sotalol güvenle kullanılabilecek iyi bir ikinci seçenek antiaritmik ajandır

Nonhidropik Fetal Atrial Flatterli Fetusda Sotalol ile Tedavi

We presented a patient in whom atrial flutter was detected during the third trimester and who was first treated with digoxin but could not tolerate it; success was then achieved on treating the patient with sotalol. A 26-years-old primigravida patient was referred to our clinic with a prediagnosis of fetal tachycardia at 32nd weeks of pregnancy. Atrial rate was detected as 533 beats/minute and ventricular rate was found as 266 beats/minute during fetal echocardiography (ECG); a diagnosis of fetal atrial flutter was made. Patient was first treated with digoxin; digoxin treatment was interrupted because of nausea, vomiting, hypotension, epigastric pain, and changes in ECG, which were associated with digoxin. Treatment was continued with sotalol in the patient who could not tolerate digoxin. It was observed that fetal heart rate decreased and returned to sinus rhythm following sotalol treatment. Pregnancy was continued until term in a healthy manner. A baby boy with a weight of 2800 g and having an Apgar score of 9 at first min and a score of 10 at fifth min was delivered by vaginal delivery. No structural abnormality was detected in the newborn during ECG. Fetal ECG is a reliable method for the diagnosis and follow-up of fetal tachyarrhythmias. Digoxin is the first-line agent in the treatment of fetal arrhythmia, but second-line agents are required in patients who cannot tolerate digoxin at therapeutic levels and present digoxin-related adverse effects. Sotalol is a good second-line antiarrhythmic agent that can be used safely

Kaynakça

Shenker L. Fetal cardiac arrhytmias. Obstet Gynecol Surv 1979; 34: 561-72. [CrossRef]

Strasburger JF, Duffy E, Gidding SS. Abnormal Doppler flow pat- terns in atrial tachycardia in infants. Am J Cardiol 1997; 80: 27-30. [CrossRef]

Copel JA, Friedman AH, Kleinman CS. Manegement of fetal cardiac arrhythmias. Obstet Gynecol Clin North Am 1997; 24: 201-11. [Cross- Ref]

Cotton JL. Identification of fetal atrial flutter by Doppler tissue imag- ing. Circulation 2001; 104: 1206-7. [CrossRef]

Vintzileos AM, Campbell WA, Soberman SM, Nochimson DJ. Fetal atrial flutter and X-linked dominant vitamin D-resistant rickets. Ob- stet Gynecol 1985; 65: 39-44.

Carvalho JS, O'Sullivan C, Shinebourne EA, Henein MY. Right and leftventricular long-axis function in the fetus using angular M-Mode. Ultrasound Obstet Gynecol 2001; 18: 619-22. [CrossRef]

De Groote KEC, Iasci A, Carvalho JS. Offline free angular M-mode a useful diagnostic tool in fetal arrhytmias. Ultrasound Obstet Gynecol 2005; 26: 327. [CrossRef]

Ebenroth ES, Cordes TM, Darragh RK. Second-line treatment of fetal supraventricular tachycardia using flecainide acetate. Pediatr Cardiol 2001; 22: 483-7. [CrossRef]

Jaeggi ET, Nii M. Fetal brady-and tachyarrhythmias: new and ac- cepted diagnostic and treatment methods. Semin Fetal Neonatal Med 2005; 10: 504-14. [CrossRef]

Krapp M, Kohl T, Simpson JM, Sharland GK, Katalinic A, Gembruch U. Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia. Heart 2003; 89: 913-7. [CrossRef]

Cuneo BF, Strasburger JF. Management strategy for fetal tachycar- dia. Obstet Gynecol 2000; 96: 575-81. [CrossRef]

Rana YS, Sodhi B, Kochar SP, Arora D. Successful Digoxin Therapy of Fetal Supraventricular Tachycardia. South Asian Federation of Ob- stetrics and Gynecology 2009; 1: 44-6. [CrossRef]

Simpson JM, Sharland GK. Fetal tachycardias: management and outcome of 127 consecutive cases. Heart 1998; 79: 576-81. [CrossRef]

Oudijk MA, Visser GH, Meijboom EJ. Fetal tachyarrhythmia - Part II: treatment. Indian Pacing Electrophysiol J 2004; 4: 185-94.

Oudjik MA, Ruskamp JM, Ververs FF, Ambachtsheer EB, Stouten- beek P, Visser GH, et al. Treatment of fetal tachycardia with sotalol: transplacental pharmacokinetics and pharmacodynamics. J Am Coll Cardiol 2003; 42: 765-70. [CrossRef]

Van der Heijden LB, Oudijk MA, Manten GT, Ter Heide H, Pistorius L, Freund MW. Sotalol as first-line treatment for fetal tachycardia and neonatal follow-up. Ultrasound Obstet Gynecol 2013; 42: 285-93. [CrossRef]

Kaynak Göster