digoxin and Tachycardia--Supraventricular

Sustained fetal supraventricular tachycardia (SVT) complicated by hydrops fetalis carries a significant risk of morbidity and mortality. While there is no clear consensus on first- and second-line therapy options for the management of fetal SVT with or without hydrops fetalis, there exists significant nonrandomized experience with a number of antiarrhythmic agents that has founded the basis for management. Furthermore, recently published meta-analyses and ongoing multicenter prospective studies have aimed to bridge the gap in the literature. We report two cases of sustained fetal SVT with severe secondary hydrops fetalis managed successfully with flecainide-sotalol combination therapy in one case and sotalol-digoxin combination therapy in the second and review the literature for the management of fetal SVT.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Drug Therapy, Combination; Female; Fetal Diseases; Flecainide; Humans; Hydrops Fetalis; Pregnancy; Sotalol; Tachycardia, Supraventricular; Young Adult

The optimal treatment for foetal supraventricular tachycardia (SVT) in twin pregnancies is unclear because of the possible impact on the second twin. This review compared a foetus we treated with antiarrhythmic drugs with the previous case studies.. Our case was a dichorionic diamniotic twin pregnancy, where one twin developed foetal hydrops secondary to SVT at 22 weeks of gestation. We searched PubMed to look for previous cases of SVT in twin pregnancies.. Treatment with transplacental antiarrhythmic therapy from 22 to 36 weeks of gestation successfully resolved the SVT in our affected twin without any impact on the healthy twin or mother. We only found seven similar cases of SVT in twin pregnancies from 1999 to 2017. Although there was no consensus on the treatment that should be provided, none of the studies reported side effects in the twins or the mothers.. Despite a lack of data on SVT in twin pregnancies, our case, and the previous cases we identified, allowed us to conclude that transplacental antiarrhythmic treatment can successfully achieve cardioversion in the affected twin. It can do this without side effects for the healthy foetus or the mother, even if the treatment lasts for a long period of time.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Female; Flecainide; Humans; Hydrops Fetalis; Pregnancy; Pregnancy, Twin; Tachycardia, Supraventricular

The use of digoxin in the therapy of systolic heart failure and certain supraventricular tachycardias is controversial. This review of the art and science of digoxin presents information needed by physicians considering digoxin therapy for these common cardiovascular disorders.

Topics: Aged; Cardiotonic Agents; Digoxin; Heart Failure, Systolic; Humans; Tachycardia, Supraventricular

Sustained fetal supraventricular tachycardia (SVT) with a heart rate of approximately 210 bpm may lead to increased atrial and venous pressures and congestive heart failure. There is no clear consensus regarding the best drug-treatment regimens for fetal SVT. However, considerable nonrandomized experience in the transmaternal treatment of fetal SVT is available with a number of antiarrhythmic agents. We report a case of fetal supraventricular tachyarrhythmia with hydrops detected at 32 weeks that was managed with combination of oral digoxin and sotalol and review management guidelines available in the literature.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Drug Therapy, Combination; Female; Humans; Hydrops Fetalis; Infant, Newborn; Pregnancy; Prenatal Care; Sotalol; Sympatholytics; Tachycardia, Supraventricular

We report a case of nonimmune hydrops fetalis detected at 32 weeks of gestation. Fetal heart rate was 300 beats per minute. Ultrasound and fetal Doppler echocardiography showed it to be due to supraventricular tachycardia (SVT). Following failed maternal therapy with digoxin alone, amiodarone with digoxin was used. Conversion to sinus rhythm and resolution of hydrops followed this treatment. Since there is no ideal treatment protocol for these cases at present, we reviewed reports of transplacental treatment of SVT.

Topics: Adult; Amiodarone; Anti-Arrhythmia Agents; Digoxin; Drug Therapy, Combination; Echocardiography, Doppler; Female; Fetal Diseases; Humans; Hydrops Fetalis; Maternal-Fetal Exchange; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Prenatal

Postoperative atrial fibrillation is a common complication after open heart surgery; it increases morbidity, hospital stay, and costs. In an analysis of 8 large cardiac surgery trials totaling 20,193 patients, the incidence of postoperative atrial fibrillation was estimated to be 26% and ranged from 17% to 35%. We reviewed the results of 52 studies published between 1966 and 2003 that evaluated pharmacologic strategies to prevent postoperative atrial fibrillation in nearly 10,000 patients undergoing open heart operations. Supraventricular tachyarrhythmias, including atrial fibrillation, after open heart operations occurred in 29% of patients who did not receive prophylactic drugs, compared with 12% in patients who received intravenous followed by oral amiodarone, 15% in those given sotalol, 16% in those given oral amiodarone, and 19% in those given beta-blockers. Pharmacologic strategies and regimens aimed at preventing postoperative atrial fibrillation are necessary to optimize the postoperative care of patients undergoing open heart operations. Although no strategy has consistently been shown to be superior to another, the most effective approach to preventing postoperative atrial fibrillation likely involves multiple interventions. In the absence of contraindications, all patients should receive beta-blocker therapy before and after the operation. For patients with 1 or more risk factors for postoperative atrial fibrillation, regimens consisting of either sotalol (beta-blocker with class III antiarrhythmic properties) alone or beta-blockers in combination with amiodarone seem to be the safest, most effective pharmacologic strategies for preventing postoperative atrial fibrillation.

Topics: Adrenergic beta-Antagonists; Amiodarone; Angiotensin II; Anti-Arrhythmia Agents; Atrial Fibrillation; Calcium Channel Blockers; Cardiac Surgical Procedures; Digoxin; Humans; Postoperative Care; Risk Factors; Sotalol; Tachycardia, Supraventricular

The protocols mentioned are used by Utrecht University Hospital for the treatment of foetal supraventricular tachycardias. In the case of atrial flutters the pregnant woman is treated with sotalol administered orally and, if no sinus rhythm is obtained nor a reduced ventricular rhythm occurs, subsequently with digoxin. If there is no hydrops foetalis then this is also the treatment regimen for other forms of foetal supraventricular tachycardia. In the case of hydrops foetalis the treatment is more aggressive: digoxin intravenously or flecanide orally; if the rhythm does not convert into a sinus rhythm nor a reduced ventricular rhythm occurs then both of these medications are administered; if that also proves to be insufficient then direct foetal therapy can be considered.

Topics: Anti-Arrhythmia Agents; Atrial Flutter; Clinical Protocols; Digoxin; Drug Therapy, Combination; Female; Fetal Diseases; Flecainide; Humans; Hydrops Fetalis; Infant, Newborn; Pregnancy; Pregnancy Complications, Cardiovascular; Sotalol; Tachycardia, Supraventricular

Fetal supraventricular tachycardia is a rare complication of pregnancy associated with cardiac failure, hydrops, and fetal death. If no underlying cardiac defects are present, medical management with digoxin has been successful.. A young woman with a triplet pregnancy presented at 23 17 weeks' gestation for routine Doppler auscultation which suggested fetal supraventricular tachycardia, confirmed by M-mode echocardiography. She was treated with oral digoxin for the remainder of her pregnancy with subsequent conversion of the tachycardic triplet to normal sinus rhythm with occasional premature atrial beats. After delivery, the triplet previously demonstrating supraventricular tachycardia had a normal sinus rhythm.. Digoxin might be used safely and successfully to treat fetal supraventricular tachycardia in multifetal pregnancies.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Female; Fetal Diseases; Humans; Pregnancy; Pregnancy, Multiple; Tachycardia, Supraventricular; Triplets

Fetal tachyarrhythmia may constitute a risk for the fetus, therefore early treatment is indicate for all cases of tachydysrhythmia, with or without hydrops, in order to prevent irreversible hydrops. A case report is described of supraventricular paroxysmal tachycardia with digoxin in utero therapy in which pharmacological intervention was successful. Some comments are regarding the experience of the multidisciplinary team at Bissaya-Barreto Maternity in the treatment and orientation of fetal tachydysrhythmias.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Echocardiography; Female; Fetal Diseases; Humans; Pregnancy; Tachycardia, Paroxysmal; Tachycardia, Supraventricular; Ultrasonography, Prenatal

Intravenous antiarrhythmic drugs will continue to have an important role in the acute management of SVT. Long-term antiarrhythmic drug therapy is often effective in preventing or reducing frequency and severity of arrhythmic episodes. The cost, adverse effects, and inconvenience of long-term drug therapy will result in the increasing use of curative ablation for most individuals with problematic SVT.

Topics: Adenosine; Amiodarone; Anti-Arrhythmia Agents; Atrial Flutter; Calcium Channel Blockers; Digoxin; Electrocardiography; Humans; Potassium Channel Blockers; Sotalol; Tachycardia, Paroxysmal; Tachycardia, Supraventricular

Topics: Adrenergic beta-Antagonists; Chi-Square Distribution; Coronary Artery Bypass; Digoxin; Female; Humans; Incidence; Male; Meta-Analysis as Topic; Middle Aged; Tachycardia, Supraventricular

Digitalis should be used for slowing a rapid ventricular rate in atrial fibrillation or atrial flutter unassociated with the preexcitation syndrome. Digitalis may be used to convert paroxysmal supraventricular tachycardia to sinus rhythm. Patients with the tachycardia-bradycardia syndrome should receive maintenance doses of digitalis after pacemaker implantation. Digitalis should not be used for treating CHF with normal LV systolic function unless a supraventricular tachyarrhythmia is present. Conflicting studies have been reported as to the efficacy of digoxin in the treatment of patients with CHF in sinus rhythm. Digoxin may be used for treating CHF with abnormal LV systolic function which does not respond to diuretics and ACE inhibitors or in patients unable to tolerate ACE inhibitor or other vasodilator therapy. Digitalis has a low toxic-therapeutic ratio, especially in elderly persons. Digoxin-specific Fab antibody fragments may be used for treating digitalis toxicity refractory to conventional measures with a treatment response in at least 90% of patients with advanced and potentially life-threatening digitalis toxicity.

Topics: Clinical Trials as Topic; Digitalis; Digoxin; Female; Heart Failure; Humans; Male; Plants, Medicinal; Plants, Toxic; Tachycardia, Supraventricular

We have reviewed the records of 65 children with paroxysmal supraventricular tachycardia (PST) without congenital heart disease followed a mean of 4 years, with a total of 121 episodes. PST appeared before 6 months of age in 42 (64.6%) children. Thirteen patients (20%) had a present factor which might predispose to PST in 66.2% of the patients who were younger than 6 months of age, and in only 4.3% of those over 6 months. Wolff-Parkinson-White syndrome was present on surface ECG during sinus rhythm in 26.1% of children younger than 6 months, and in 39.1% of those over 6 months. Digoxin was the initial treatment in 84.3% of the episodes with a success rate of 75% when were employed alone and of 84.2% when were employed in combination of quinidine. PST recurred at least once in 35 children (53.8%), the 90% within three months of the first episode. All patients were alive and 63 (96.9%) doing well. One patient developed cerebral anoxia and now has hemiparesia and another patient has incessant PST. We conclude that children with PST without congenital heart disease and without delay in diagnosis had a good outcome.

Topics: Amiodarone; Child; Child, Preschool; Digoxin; Female; Humans; Male; Propranolol; Tachycardia, Paroxysmal; Tachycardia, Supraventricular

We reviewed the records of 26 infants with congenital junctional ectopic tachycardia (JET) from seven institutions to examine the evolution in the management of this tachycardia that is difficult to treat. JET was defined electrocardiographically as an incessant tachycardia with normal QRS morphology and atrioventricular (AV) dissociation. The ventricular rate ranged from 140 to 370 beats/min (mean, 230 beats/min); 16 of 26 patients had cardiac failure. Treatment success was defined as a stable decrease in the rate of JET, below 150 beats/min; partial success was a significant decrease of JET rate with alleviation of symptoms. All patients received digoxin with no significant effect. Propranolol was given to 16 patients, with two successes and one partial success. Combinations of other conventional agents were used in 11 patients with two successes; 14 patients were treated with amiodarone, which resulted in eight successes and three partial successes; three patients died suddenly on medical treatment (amiodarone, one patient; propranolol, one patient; or amiodarone plus propranolol, one patient); sudden AV block was a possible cause and consequently, two later patients had pacemaker implantation as well as medical treatment. His catheter ablation was successfully performed twice but contributed to death in a newborn; three surgical His ablations were performed for intractable JET with two successes and one death. The overall mortality was 35%. Among survivors, treatment has been stopped without any complications in five patients ranging in age from 10 months to 8 years (mean, 3.5 years). It seems that amiodarone alone is the best drug for treatment of congenital JET; necessity for permanent pacing remains unsettled. His ablation should be reserved only for intractable JET.

Topics: Amiodarone; Bundle of His; Digoxin; Drug Therapy, Combination; Echocardiography; Humans; Infant; Multicenter Studies as Topic; Pacemaker, Artificial; Propranolol; Tachycardia, Ectopic Junctional; Tachycardia, Supraventricular

We report on a 33-year-old para II who was admitted to our hospital in her 29th gestational week with extensive fetal hydrops. Examinations showed a fetal supraventricular tachycardia with biventrical cardiac insufficiency. Digoxin was given both to the mother and to the fetus. At first, this treatment seemed to have no effect. Over a period of several weeks, however, oral therapy with digoxin and verapamil resulted in a stabilized fetal heart rate (175-180 beats/min). Signs of fetal cardiac insufficiency disappeared almost completely. In the 39th week the child was born spontaneously. Clinical examination revealed only a slight cardiac insufficiency. New possibilities of intrauterine therapy are discussed in the light of this case and other reports in the literature.

Topics: Adult; Digoxin; Drug Therapy, Combination; Female; Heart Failure; Heart Rate, Fetal; Humans; Hydrops Fetalis; Infant, Newborn; Pregnancy; Pregnancy Trimester, Third; Tachycardia, Supraventricular; Verapamil

The management of fetal heterotopic tachycardias is reviewed from a cooperative study involving 23 cases treated by French Pediatric Cardiology Centers at Angers, Brest, Nantes, Rennes and Tours. There were 17 cases of supraventricular tachycardia (SVT), 5 of flutter and 1 of atrial tachycardia. Seventeen mothers were given an antiarrythmic treatment. They all received Digoxin by mouth, with either Propranolol in 2 cases, Sotalol and Verapamil in one case each. In 5 cases 2 or more other drugs were associated. There was a good in utero response in 12 cases. Among the 23 patients, 5 died, all with hydrops fetalis at the time of diagnosis of SVT. Finally 2 newborns were successfully treated at the time of delivery by a direct puncture of the umbilical cord.

Topics: Anti-Arrhythmia Agents; Digoxin; Drug Therapy, Combination; Female; Fetal Diseases; Humans; Infant, Newborn; Multicenter Studies as Topic; Pregnancy; Prenatal Diagnosis; Prospective Studies; Retrospective Studies; Tachycardia, Supraventricular; Ultrasonography

Standardized treatment of fetal tachyarrhythmia has not been established.. This study sought to evaluate the safety and efficacy of protocol-defined transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL).. In this multicenter, single-arm trial, protocol-defined transplacental treatment using digoxin, sotalol, and flecainide was performed for singleton pregnancies from 22 to <37 weeks of gestation with sustained fetal SVT or AFL ≥180 beats/min. The primary endpoint was resolution of fetal tachyarrhythmia. Secondary endpoints were fetal death, pre-term birth, and neonatal arrhythmia. Adverse events (AEs) were also assessed.. A total of 50 patients were enrolled at 15 institutions in Japan from 2010 to 2017; short ventriculoatrial (VA) SVT (n = 17), long VA SVT (n = 4), and AFL (n = 29). One patient with AFL was excluded because of withdrawal of consent. Fetal tachyarrhythmia resolved in 89.8% (44 of 49) of cases overall and in 75.0% (3 of 4) of cases of fetal hydrops. Pre-term births occurred in 20.4% (10 of 49) of patients. Maternal AEs were observed in 78.0% (39 of 50) of patients. Serious AEs occurred in 1 mother and 4 fetuses, thus resulting in discontinuation of protocol treatment in 4 patients. Two fetal deaths occurred, mainly caused by heart failure. Neonatal tachyarrhythmia was observed in 31.9% (15 of 47) of neonates within 2 weeks after birth.. Protocol-defined transplacental treatment for fetal SVT and AFL was effective and tolerable in 90% of patients. However, it should be kept in mind that serious AEs may take place in fetuses and that tachyarrhythmias may recur within the first 2 weeks after birth.

Topics: Administration, Oral; Adult; Anti-Arrhythmia Agents; Atrial Flutter; Cesarean Section; Digoxin; Female; Fetal Death; Fetal Diseases; Flecainide; Humans; Infant, Newborn; Injections, Intravenous; Japan; Natriuretic Peptide, Brain; Pregnancy; Pregnancy Complications; Premature Birth; Prenatal Care; Recurrence; Sotalol; Tachycardia; Tachycardia, Supraventricular; Umbilical Veins; Young Adult

Conflicting data exist for the appropriate management of a neonate with supraventricular tachycardia (SVT). We sought to assess postnatal prescribing trends for neonates with SVT and to evaluate if there were therapy-specific mortality and resource utilization benefits. Nationally distributed data from 44 pediatric hospitals in the 2004 to 2015 Pediatric Health Information System database were used to identify patients admitted at ≤2 days of age with structurally normal hearts and treated with an antiarrhythmic medication. Outcome variables were mortality, cost, and length of stay (LOS). Multivariable models and propensity score matching were used. There were 2,657 neonates identified with a median gestational age of 37 weeks (interquartile range 34 to 39). Digoxin and propranolol were most commonly prescribed; digoxin use steadily decreased to 23% of antiarrhythmic medication administrations over the study period, whereas propranolol increased to 77%. Multivariable comparisons revealed that the odds of mortality for neonates on propranolol were 0.32 times those on digoxin (95% confidence interval 0.17 to 0.59; p <0.001); hospital costs were $16,549 lower for propranolol versus digoxin (95% confidence interval $5,502 to $27,596, p = 0.003). No difference was found for LOS. Propensity score matching and subset analyses of patients with only arrhythmia diagnostic codes confirmed mortality benefits for propranolol, although longer LOS was observed. In conclusion, propranolol use for the neonate with SVT is associated with lower in-hospital mortality and hospital costs compared with digoxin.

Topics: Anti-Arrhythmia Agents; Arkansas; Digoxin; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Health Information Systems; Hospital Mortality; Hospitals, Pediatric; Humans; Infant, Newborn; Male; Propranolol; Recurrence; Retrospective Studies; Tachycardia, Supraventricular; Treatment Outcome

Supraventricular tachycardia (SVT) is one of the most common conditions requiring emergent cardiac care in children, yet its management has never been subjected to a randomized controlled clinical trial. The purpose of this study was to compare the efficacy and safety of the 2 most commonly used medications for antiarrhythmic prophylaxis of SVT in infants: digoxin and propranolol.. This was a randomized, double-blind, multicenter study of infants <4 months with SVT (atrioventricular reciprocating tachycardia or atrioventricular nodal reentrant tachycardia), excluding Wolff-Parkinson-White, comparing digoxin with propranolol. The primary end point was recurrence of SVT requiring medical intervention. Time to recurrence and adverse events were secondary outcomes. Sixty-one patients completed the study, 27 randomized to digoxin and 34 to propranolol. SVT recurred in 19% of patients on digoxin and 31% of patients on propranolol (P=0.25). No first recurrence occurred after 110 days of treatment. The 6-month recurrence-free status was 79% for patients on digoxin and 67% for patients on propranolol (P=0.34), and there were no first recurrences in either group between 6 and 12 months. There were no deaths and no serious adverse events related to study medication.. There was no difference in SVT recurrence in infants treated with digoxin versus propranolol. The current standard practice may be treating infants longer than required and indicates the need for a placebo-controlled trial. Clinical Trial Registration Information- http://clinicaltrials.gov; NCT-00390546.

Topics: Anti-Arrhythmia Agents; Canada; Chi-Square Distribution; Digoxin; Double-Blind Method; Female; Humans; Infant; Infant, Newborn; Male; Proportional Hazards Models; Propranolol; Recurrence; Tachycardia, Supraventricular; Treatment Outcome; United States

To evaluate magnesium as a sole or adjuvant agent with currently used prophylactic drugs in suppressing postoperative atrial tachyarrhythmias (POAT) after coronary artery bypass graft (CABG) surgery.. Single-center prospective, randomized clinical trial.. University hospital.. Patients (n = 400) undergoing CABG surgery.. Patients were randomized among 6 prophylaxis regimens: (1) control (no antiarrhythmics), (2) magnesium only, (3) digoxin only, (4) magnesium and digoxin, (5) propranolol only, and (6) magnesium and propranolol. Patients randomized to a regimen including magnesium received 12 g given during 96 hours postoperatively. Patients in a digoxin regimen received 1 mg after cardiopulmonary bypass and 0.25 mg daily. Patients in a propranolol regimen received 1 mg intravenously every 6 hours until able to take 10 mg orally 4 times a day. Prophylaxis regimens were discontinued after 4 days postoperatively.. The primary outcome was a sustained POAT or discharge from the hospital. Control patients had an incidence of POAT (38%) not significantly different from patients in magnesium-only (38%), digoxin-only (31%), and magnesium with digoxin (37%) regimens. Patients treated with propranolol had a significant reduction in POAT. Nearly identical POAT rates in the propranolol-only (18%) and propranolol with magnesium (19%) groups support the lack of efficacy of magnesium in this trial. Study design allowed analysis of and showed a beta-blocker withdrawal effect in addition to suppressive benefit of postoperative beta-blockers.. beta-Blocker prophylaxis is indicated to reduce the incidence of POAT in CABG surgery patients and to prevent a beta-blocker withdrawal effect in patients receiving these medications preoperatively. Digoxin and magnesium as sole or adjuvant agents do not offer suppressive or ventricular rate reduction benefits in POAT.

Topics: Adrenergic beta-Antagonists; Aged; Cardiotonic Agents; Coronary Artery Bypass; Digoxin; Female; Humans; Magnesium; Male; Middle Aged; Postoperative Complications; Propranolol; Prospective Studies; Tachycardia, Supraventricular

The incidence, predictive factors, morbidity, and mortality associated with the development of supraventricular tachyarrhythmias (SVTs) in patients with congestive heart failure (CHF) are poorly defined.. In the Digitalis Investigation Group trial, patients with CHF who were in sinus rhythm were randomly assigned to digoxin (n = 3,889) or placebo (n = 3,899) and followed up for a mean of 37 months. Baseline factors that predicted the occurrence of SVT and the effects of SVT on total mortality, stroke, and hospitalization for worsening CHF were determined.. Eight hundred sixty-six patients (11.1%) had SVT during the study period. Older age (odds ratio [OR], 1.029 for each year increase in age; p = 0.0001), male sex (OR, 1.270; p = 0.0075), increasing duration of CHF (OR, 1.003 for each month increase in duration of CHF; p = 0.0021), and a cardiothoracic ratio of > 0.50 (OR, 1.403; p = 0.0001) predicted an increased risk of experiencing SVT. Left ventricular ejection fraction, New York Heart Association functional class, and treatment with digoxin vs placebo were not related to the occurrence of SVT. After adjustment for other risk factors, development of SVT predicted a greater risk of subsequent total mortality (risk ratio [RR] = 2.451; p = 0.0001), stroke (RR = 2.352; p = 0.0001), and hospitalization for worsening CHF (RR = 3. 004; p = 0.0001).. In CHF patients in sinus rhythm, older age, male sex, longer duration of CHF, and increased cardiothoracic ratio predict an increased risk for experiencing SVT. Development of SVT is a strong independent predictor of mortality, stroke, and hospitalization for CHF in this population. Prevention of SVT may prolong survival and reduce morbidity in CHF patients.

Topics: Age Factors; Aged; Cardiotonic Agents; Digoxin; Double-Blind Method; Female; Heart Failure; Heart Rate; Humans; Incidence; Male; Middle Aged; Odds Ratio; Prognosis; Sex Factors; Stroke; Stroke Volume; Survival Rate; Tachycardia, Supraventricular

Atrial fibrillation (AF) shortens the atrial effective refractory period (ERP) and predisposes to further episodes of AF. The acute changes in atrial refractoriness may be related to tachycardia-induced intracellular calcium overload. The purpose of this study was to determine whether digoxin, which increases intracellular calcium, potentiates the acute effects of AF on atrial refractoriness in humans.. In 38 healthy adults, atrial ERP was measured at basic drive cycle lengths (BDCLs) of 350 and 500 ms after autonomic blockade. Nineteen patients had been treated with digoxin for 2 weeks. After a several-minute episode of AF, atrial ERP was measured serially at alternating BDCLs. Compared with pre-AF ERPs, the first post-AF ERPs were significantly shorter in both the digoxin and the control groups (P:<0.001). The post-AF ERP at a BDCL of 350 ms shortened to a greater degree in the digoxin group (37+/-16 ms) than in the control group (20+/-13 ms, P:<0.001); similar changes occurred at a BDCL of 500 ms. During post-AF determinations of the atrial ERP, secondary AF episodes occurred significantly more often in the digoxin group (32% versus 16%; P:<0. 04).. After a brief episode of AF, digoxin augments the shortening that occurs in atrial refractoriness and predisposes to the reinduction of AF. These effects occur in the setting of autonomic blockade and therefore are more likely to be due to the effects of digoxin on intracellular calcium than to its vagotonic effects.

Topics: Administration, Oral; Adrenergic beta-Antagonists; Adult; Atrial Fibrillation; Calcium; Cardiac Pacing, Artificial; Cardiotonic Agents; Digoxin; Electrocardiography; Female; Heart Atria; Heart Rate; Humans; Infusions, Intravenous; Intracellular Fluid; Male; Parasympatholytics; Reaction Time; Tachycardia, Supraventricular; Tachycardia, Ventricular

The purpose of this study was to evaluate the efficacy of maternal digoxin administration in 16 cases of fetal supraventricular tachyarrhythmia diagnosed by fetal echocardiography; cardiac anatomy was normal in all cases. The retrospective analysis included nine mothers who received digoxin orally in most cases, with control of the arrhythmia in two fetuses. The addition of amiodarone (five cases) and propranolol (two cases) yielded two successes with amiodarone. The therapeutic regimen of digoxin was then modified on the basis of poor response to orally administered digoxin. In the prospective study, digoxin was administered intravenously to seven mothers according to a standard protocol; high doses (1 to 2 mg intravenously) were prescribed for the first 24 hours and intravenous digoxin therapy was maintained for at least 5 days, depending on the fetal response. Digoxin pharmacokinetic studies of four mothers showed an increased plasma clearance and reduced elimination half-life. Digoxin controlled the five supraventricular tachycardias (with hydrops in four cases). Maternal flecainide therapy restored sinus rhythm in two cases of atrial flutter. Our prospective study emphasizes the efficacy and safety for the fetus and the mother of intravenously administered digoxin as a first-choice drug in the treatment of supraventricular tachyarrhythmias. Flecainide may be a promising second-choice drug but requires further clinical investigation. Amiodarone and propranolol seem to be ineffective.

Topics: Digoxin; Drug Therapy, Combination; Fetal Diseases; Flecainide; Humans; Prospective Studies; Retrospective Studies; Tachycardia, Supraventricular

Transplacentally administered digoxin is the drug of choice for the treatment of fetal supraventricular tachycardia. We describe a case of fetal supraventricular tachycardia associated with fetal hydrops that did not respond to digoxin treatment because of a lack of transplacental passage. In contrast, flecainide acetate crossed the placenta and cured the fetus. The clinical implications of this new treatment are discussed.

Topics: Adult; Digoxin; Female; Fetal Diseases; Flecainide; Humans; Pregnancy; Tachycardia, Supraventricular

We reviewed the records of 26 infants with congenital junctional ectopic tachycardia (JET) from seven institutions to examine the evolution in the management of this tachycardia that is difficult to treat. JET was defined electrocardiographically as an incessant tachycardia with normal QRS morphology and atrioventricular (AV) dissociation. The ventricular rate ranged from 140 to 370 beats/min (mean, 230 beats/min); 16 of 26 patients had cardiac failure. Treatment success was defined as a stable decrease in the rate of JET, below 150 beats/min; partial success was a significant decrease of JET rate with alleviation of symptoms. All patients received digoxin with no significant effect. Propranolol was given to 16 patients, with two successes and one partial success. Combinations of other conventional agents were used in 11 patients with two successes; 14 patients were treated with amiodarone, which resulted in eight successes and three partial successes; three patients died suddenly on medical treatment (amiodarone, one patient; propranolol, one patient; or amiodarone plus propranolol, one patient); sudden AV block was a possible cause and consequently, two later patients had pacemaker implantation as well as medical treatment. His catheter ablation was successfully performed twice but contributed to death in a newborn; three surgical His ablations were performed for intractable JET with two successes and one death. The overall mortality was 35%. Among survivors, treatment has been stopped without any complications in five patients ranging in age from 10 months to 8 years (mean, 3.5 years). It seems that amiodarone alone is the best drug for treatment of congenital JET; necessity for permanent pacing remains unsettled. His ablation should be reserved only for intractable JET.

Topics: Amiodarone; Bundle of His; Digoxin; Drug Therapy, Combination; Echocardiography; Humans; Infant; Multicenter Studies as Topic; Pacemaker, Artificial; Propranolol; Tachycardia, Ectopic Junctional; Tachycardia, Supraventricular

The effectiveness and electrophysiologic mechanisms of antiarrhythmic effect of digoxin were examined in 27 patients with paroxysmal atrioventricular nodal reciprocal tachycardia (PAVNRT) and supraventricular tachycardia (SVT) due to latent complementary conductive pathways, i. e. latent Wolff-Parkinson-White (WPW) syndrome. To assess antiarrhythmic action of digoxin, transesophageal pacing and plasma digoxin radioimmonoassays were used. Preventive antiarrhythmic efficiency of digoxin was 53% in PAVNRT patients, and 25% in SVT patients with latent WPW syndrome. Antegrade atrioventricular conduction block seems to be the mechanism of oral digoxin preventive effect. There was no relationship between antiarrhythmic efficiency of digoxin and its plasma level.

Topics: Action Potentials; Adolescent; Adult; Anti-Arrhythmia Agents; Atrioventricular Node; Child; Clinical Trials as Topic; Digoxin; Female; Humans; Male; Middle Aged; Tachycardia, Atrioventricular Nodal Reentry; Tachycardia, Paroxysmal; Tachycardia, Supraventricular

The management of fetal heterotopic tachycardias is reviewed from a cooperative study involving 23 cases treated by French Pediatric Cardiology Centers at Angers, Brest, Nantes, Rennes and Tours. There were 17 cases of supraventricular tachycardia (SVT), 5 of flutter and 1 of atrial tachycardia. Seventeen mothers were given an antiarrythmic treatment. They all received Digoxin by mouth, with either Propranolol in 2 cases, Sotalol and Verapamil in one case each. In 5 cases 2 or more other drugs were associated. There was a good in utero response in 12 cases. Among the 23 patients, 5 died, all with hydrops fetalis at the time of diagnosis of SVT. Finally 2 newborns were successfully treated at the time of delivery by a direct puncture of the umbilical cord.

Topics: Anti-Arrhythmia Agents; Digoxin; Drug Therapy, Combination; Female; Fetal Diseases; Humans; Infant, Newborn; Multicenter Studies as Topic; Pregnancy; Prenatal Diagnosis; Prospective Studies; Retrospective Studies; Tachycardia, Supraventricular; Ultrasonography

Topics: Adolescent; Adrenergic beta-Antagonists; Cardiomyopathy, Dilated; Child; Child, Preschool; Chronic Disease; Clinical Trials as Topic; Cryosurgery; Diagnosis, Differential; Digoxin; Drug Therapy, Combination; Female; Heart Block; Humans; Infant; Male; Tachycardia, Ectopic Atrial; Tachycardia, Sinus; Tachycardia, Supraventricular

While in-utero treatment of sustained fetal supraventricular arrhythmia (SVA) is standard practice in the previable and preterm fetus, data are limited on best practice for late preterm (34 + 0 to 36 + 6 weeks), early term (37 + 0 to 38 + 6 weeks) and term (> 39 weeks) fetuses with SVA. We reviewed the delivery and postnatal outcomes of fetuses at ≥ 35 weeks of gestation undergoing treatment rather than immediate delivery.. This was a retrospective case series of fetuses presenting at ≥ 35 weeks of gestation with sustained SVA and treated transplacentally at six institutions between 2012 and 2022. Data were collected on gestational age at presentation and delivery, SVA diagnosis (short ventriculoatrial (VA) tachycardia, long VA tachycardia or atrial flutter), type of antiarrhythmic medication used, interval between treatment and conversion to sinus rhythm and postnatal SVA recurrence.. Overall, 37 fetuses presented at a median gestational age of 35.7 (range, 35.0-39.7) weeks with short VA tachycardia (n = 20), long VA tachycardia (n = 7) or atrial flutter (n = 10). Four (11%) fetuses were hydropic. In-utero treatment led to restoration of sinus rhythm in 35 (95%) fetuses at a median of 2 (range, 1-17) days; this included three of the four fetuses with hydrops. Antiarrhythmic medications included flecainide (n = 11), digoxin (n = 7), sotalol (n = 11) and dual therapy (n = 8). Neonates were liveborn at 36-41 weeks via spontaneous vaginal delivery (23/37 (62%)) or Cesarean delivery (14/37 (38%)). Cesarean delivery was indicated for fetal SVA in two fetuses, atrial ectopy or sinus bradycardia in three fetuses and obstetric reasons in nine fetuses that were in sinus rhythm at the time of delivery. Twenty-one (57%) cases were treated for recurrent SVA after birth.. In-utero treatment of the near term and term (≥ 35-week) SVA fetus is highly successful even in the presence of hydrops, with the majority of cases delivered vaginally closer to term, thereby avoiding unnecessary Cesarean section. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Topics: Anti-Arrhythmia Agents; Atrial Flutter; Cesarean Section; Digoxin; Edema; Female; Fetal Diseases; Fetus; Humans; Hydrops Fetalis; Infant; Infant, Newborn; Pregnancy; Retrospective Studies; Tachycardia; Tachycardia, Supraventricular

Prognosis of fetuses with hydrops and tachyarrhythmia has been portrayed as poor in most published reports. This might lead to biased counselling, unnecessary caesarean section, preterm delivery, and even termination of pregnancy.. To evaluate contemporary fetal and postnatal outcomes of hydropic fetuses with fetal tachyarrhythmia when it is treated effectively and monitored systematically.. This is a retrospective review of a single centre experience at the University Hospital of Wales over a 20-year period. All fetuses received high doses of flecainide and digoxin combination treatment. Tachycardia response rate, time to arrhythmia and hydrops resolution, fetal and postnatal morbidity, and mortality rates were analysed.. Twenty fetuses were diagnosed with hydrops fetalis and received treatment. The mechanism of fetal tachyarrhythmia was supraventricular tachycardia in thirteen and atrial flutter in eight cases. Among the 20 fetuses treated, the overall tachycardia response rate was 90% (18/20) with the restoration of sinus rhythm in 85% (17/20) of the cases. The median time to restore sinus rhythm or to rate control of the arrhythmia was 1.5 days (range 12 hours to 13 days). Hydrops resolved in 17 of the 20 fetuses, with a median time of 12 days (range 3-21 days). Four fetuses went into spontaneous preterm birth and one fetus was delivered early due to worsening hydrops. No significant neurological morbidity was observed in surviving neonates and infants on clinical examination. There was one postnatal death due to respiratory complications of prematurity in the non-responsive supraventricular tachycardia case.. High-dose flecainide and digoxin combination offers effective treatment strategy in fetuses with hydrops and tachyarrhythmia with favourable outcomes. This study may guide more realistic counselling for pregnancies complicated by tachyarrhythmia and hydrops.

Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Cesarean Section; Digoxin; Female; Fetal Diseases; Flecainide; Heart Failure; Humans; Hydrops Fetalis; Infant, Newborn; Pregnancy; Premature Birth; Retrospective Studies; Tachycardia; Tachycardia, Supraventricular

Supraventricular tachycardia (SVT) is the most common arrhythmia in neonates and infants, and pharmacological therapy is recommended to prevent recurrent episodes. This retrospective study aims to describe and analyze the practice patterns, effectiveness, and outcome of drug therapy for SVT in patients within the first year of life. Among the 67 patients analyzed, 48 presented with atrioventricular re-entrant tachycardia, 18 with focal atrial, and one with atrioventricular nodal re-entrant. Fetal tachycardia was reported in 27%. Antiarrhythmic treatment consisted of beta-receptor blocking agents in 42 patients, propafenone in 20, amiodarone in 20, and digoxin in 5. Arrhythmia control was achieved with single drug therapy in 70% of the patients, 21% needed dual therapy, and 6% triple. Propafenone was discontinued in 7 infants due to widening of the QRS complex. After 12 months (6-60), 75% of surviving patients were tachycardia-free and discontinued prophylactic treatment. Patients with fetal tachycardia had a significantly higher risk of persistent tachycardia (p: 0.007). Prophylactic antiarrhythmic medication for SVT in infancy is safe and well tolerated. Arrhythmia control is often achieved with single medication, and after cessation, most patients are free of arrhythmias. Infants with SVT and a history of fetal tachycardia are more prone to suffer from persistent SVT and relapses after cessation of prophylactic antiarrhythmic medication than infants with the first episode of SVT after birth.

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Digoxin; Humans; Infant; Infant, Newborn; Propafenone; Retrospective Studies; Tachycardia, Supraventricular

To evaluate systolic and diastolic cardiac function in children who had cardiomyopathy induced by ectopic atrial tachycardia (EAT).. Twenty-two pediatric patients who had cardiomyopathy induced by EAT and 25 age-matched controls were recruited in this case-control study. The patients were examined after rhythm control and normalization of their left ventricular systolic function. Different echocardiographic modalities including tissue Doppler imaging and two-dimension speckle tracking echocardiography were utilized to assess the ventricular and atrial function.. The patients' median age was 51 months (interquartile range: 28.5-84 months). The median time interval required for normalization of left ventricular ejection fraction (EF) among patients was 1.5 months (interquartile range: 1.5-2.12 months). Compared to controls, patients had a significantly higher median left ventricular myocardial performance index (MPI) at the interventricular septum (0.44 vs. 0.38, p = .001) and left ventricular lateral wall (0.46 vs. 0.32, p = .0001). The median right ventricular MPI of the patients' group was significantly higher when compared to the control group (0.34 vs. 0.26, p = .0001). The median right atrial (RA) reservoir function in patients was significantly reduced compared to controls (30% vs. 36.63%, p = .007).. Shortly after rhythm normalization and restoration of left ventricular EF, using tissue Doppler imaging and two-dimension speckle tracking echocardiography, children who had cardiomyopathy induced by EAT continue to have left ventricular diastolic dysfunction, right ventricular dysfunction, and reduced RA reservoir function.

Topics: Adrenergic beta-Antagonists; Amiodarone; Anti-Arrhythmia Agents; Cardiomyopathy, Dilated; Case-Control Studies; Child; Child, Preschool; Diastole; Digoxin; Drug Therapy, Combination; Echocardiography, Doppler; Electrocardiography; Female; Humans; Infant; Male; Recovery of Function; Systole; Tachycardia, Supraventricular

Supraventricular tachycardias (SVTs) are common in the first year of life and may be life-threatening. Acute cardioversion is usually effective, with both pharmacological and non-pharmacological procedures. However, as yet no international consensus exists concerning the best drug required for a stable conversion to sinus rhythm (maintenance treatment). Our study intends to describe the experience of a single centre with maintenance drug treatment of both re-entry and automatic SVTs in the first year of life.. From March 1995 to April 2019, 55 patients under one year of age with SVT were observed in our Centre. The SVTs were divided into two groups: 45 re-entry and 10 automatic tachycardias. As regards maintenance therapy, in re-entry tachycardias, we chose to start with oral flecainide and in case of relapses switched to combined treatment with beta-blockers or digoxin. In automatic tachycardias we first administered a beta-blocker, later combined with flecainide or amiodarone when ineffective.. The patients' median follow-up time was 35 months. In re-entry tachycardias, flecainide was effective as monotherapy in 23/45 patients (51.1%) and in 20/45 patients (44.4%) in combination with nadolol, sotalol or digoxin (overall 95.5%). In automatic tachycardias, a beta-blocker alone was effective in 3/10 patients (30.0%), however, the best results were obtained when combined with flecainide: overall 9/10 (90%).. In this retrospective study on pharmacological treatment of SVTs under 1 year of age the combination of flecainide and beta-blockers was highly effective in long-term maintenance of sinus rhythm in both re-entry and automatic tachycardias.

Topics: Action Potentials; Adrenergic beta-Antagonists; Age Factors; Anti-Arrhythmia Agents; Digoxin; Drug Therapy, Combination; Female; Flecainide; Heart Rate; Humans; Infant; Infant, Newborn; Male; Nadolol; Recurrence; Retrospective Studies; Sotalol; Tachycardia, Supraventricular; Time Factors; Treatment Outcome; Voltage-Gated Sodium Channel Blockers

We present a special case of fetal supraventricular tachycardia detected at 34 weeks gestation. Fetal hydrops was noted on ultrasound upon admission. Normal fetal heart rate was maintained for three weeks by maternal administration of digoxin. A live infant was delivered via caesarian section at 37 weeks gestation. This clinical case demonstrated that pharmacological treatment can be effective and helps to prolong pregnancy safely.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Female; Humans; Hydrops Fetalis; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Prenatal

We present a man undergoing regular haemodialysis sessions, who presented with non-specific symptoms of nausea, vomiting and light-headedness. He was found to have significantly raised serum digoxin concentrations, as well as a heart rate of 30 beats per minutes. An ECG showed complete heart block. He has a history of non-ischaemic dilated cardiomyopathy with resistant supraventricular and ventricular tachycardias and was on concomitant beta-blockade and digoxin. On questioning, he reported a gradual decline in his residual urine output over the past 6 months. He was reviewed by the cardiology team and required both pharmacological therapy for reversal of digoxin toxicity and temporary pacing in view of significant bradyarrhythmias. The beta-blockade and digoxin were discontinued. He was kept on continuous monitoring at the Cardiac Critical Care Unit. His symptoms resolved spontaneously once digoxin-specific antibody fragments were administered and temporary pacing successfully performed.

Topics: Aged; Anti-Arrhythmia Agents; Bradycardia; Cardiac Pacing, Artificial; Cardiomyopathy, Dilated; Digoxin; Drug-Related Side Effects and Adverse Reactions; Electrocardiography; Humans; Immunoglobulin Fab Fragments; Kidney Failure, Chronic; Male; Protective Agents; Renal Dialysis; Risk Adjustment; Tachycardia, Supraventricular; Treatment Outcome

A 21-year-old G3P2011 Caucasian woman at 27 weeks' gestation presented with fetal tachyarrhythmia between 240 and 270 beats per minute. Fetal supraventricular tachycardia, abdominal ascites, pleural effusion and pericardial effusion indicated hydrops fetalis. Management with digoxin and flecainide converted the fetus to sinus rhythm and resolved the ascites and pleural effusion within 4 days of treatment. Flecainide was discontinued at 31 weeks' gestation due to elevated liver enzymes. Intrahepatic cholestasis was treated with ursodiol. Caesarean section was performed at 37 weeks' gestation. Neonatal echocardiogram revealed a bicuspid aortic valve with mild regurgitation and a patent foramen ovale, and the infant showed no subsequent evidence of tachyarrhythmia or hydrops after delivery. Treatment of hydrops fetalis in the antenatal period is complex, and early diagnosis and treatment can quickly resolve supraventricular tachycardia-induced hydrops fetalis.

Topics: Anti-Arrhythmia Agents; Cesarean Section; Digoxin; Echocardiography; Female; Fetal Therapies; Flecainide; Humans; Hydrops Fetalis; Pregnancy; Tachycardia, Supraventricular; Treatment Outcome; Ultrasonography, Prenatal; Young Adult

Fetal arrhythmias are common, and they may resolve spontaneously in majority of the cases. Sustained fetal arrhythmias associated with major structural heart disorders, hydrops fetalis, and fetal heart failure warrant intrauterine pharmaceutical conversion of heart rhythm or early pacemaker implant in order to avoid fetal demise. Fetal atrial flutter (AF) and supraventricular tachycardia (SVT) resemble in terms of the effects of intrauterine therapies. Digoxin is more suitable for rhythm conversion of fetal AF and SVT in fetuses free of hydrops fetalis, while sotalol shows better effects for those with hydrops fetalis. In fetal cases of atrioventricular blocks, an etiological treatment for the maternal antibody exposure by steroids could be an alternative remedy. In this article, the clinical diagnosis and treatment of fetal arrhythmias are presented, and advantages and disadvantages of antiarrhythmic agents for fetal arrhythmias are compared.

Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Digoxin; Female; Humans; Hydrops Fetalis; Pregnancy; Sotalol; Tachycardia, Supraventricular

This report describes a case of fetal supraventricular tachycardia (SVT) diagnosed at 12 weeks of gestation in a pregnant woman with diabetes mellitus. Transplacental digoxin therapy administered orally to the mother was unsuccessful. Subsequently, sotalol was added to digoxin to achieve fetal heart rate (HR) control and the conversion to sinus rhythm was achieved. The fetal HR remained stable until term, and a healthy male baby was born. The newborn electrocardiogram showed sinus rhythm with normal PR and QTc intervals. When the newborn was stable, he was discharged with propanolol. Sustained SVT is extremely rare during the first trimester. The goal of treatment in utero is the conversion to sinus rhythm or reduction of the ventricular rate to tolerable levels, preventing or even reversing fetal hydrops.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Echocardiography; Female; Fetal Heart; Follow-Up Studies; Humans; Infant, Newborn; Male; Pregnancy; Propranolol; Sotalol; Tachycardia, Supraventricular; Ultrasonography, Prenatal; Young Adult

Topics: Amniotic Fluid; Anti-Arrhythmia Agents; Digoxin; Drug Administration Routes; Female; Fetal Therapies; Humans; Pregnancy; Tachycardia, Supraventricular

The objective of this study was to characterize the pharmacokinetics (PK) of digoxin in pregnant women and its potential implications for drug dosing.. Serum digoxin concentrations (SDCs) obtained in pregnant women treated for fetal supraventricular tachycardia (SVT) was retrospectively collected. PK analysis was comparatively performed using a two-stage approach (PKS™) and a Population PK approach (NONMEM™). As clinical outcome the fetal heart rate was recorded.. A total of 42 SDCs were obtained from 8 women in the 3rd trimester of pregnancy (mean age 33.0 years). The PK parameters estimated by both two-stage (volume of distribution (Vd) = 682.0 L, CV = 47.5%; serum clearance (CL) = 16.1 L/h, CV = 19%) and population approaches (Vd = 731.3 L, CV = 30.5%; CL = 18.7 L/h, CV = 17.8%) are very similar and show a clear trend of increasing drug disposition in the third trimester of pregnancy. An oral loading dose of 0.5 mg/8 h during 24 h followed by a maintenance regimen of 0.5 mg/12 h been recommended to start treatment.. Despite the small population, these parameters could be used as a guide to calculate the initial dosage requirements in the third trimester of pregnancy for treating fetal SVT. In addition, maternal SDCs should be routinely monitored for dosage adjustment purposes.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Dose-Response Relationship, Drug; Female; Fetal Diseases; Humans; Models, Biological; Nonlinear Dynamics; Pregnancy; Pregnancy Trimester, Third; Retrospective Studies; Tachycardia, Supraventricular; Tissue Distribution; Young Adult

Several retrospective or single-centre studies demonstrated the efficacy of transplacental treatment of fetal tachyarrhythmias. Our retrospective nationwide survey showed that the fetal therapy will be successful at an overall rate of 90%. For fetuses with hydrops, the treatment success rate will be 80%. However, standard protocol has not been established. The objective of this study is to evaluate the efficacy and safety of the protocol-defined transplacental treatment of fetal tachyarrhythmias. Participant recruitment began in October 2010.. The current study is a multicentre, single-arm interventional study. A total of 50 fetuses will be enrolled from 15 Japanese institutions. The protocol-defined transplacental treatment is performed for singletons with sustained fetal tachyarrhythmia ≥180 bpm, with a diagnosis of supraventricular tachycardia or atrial flutter. Digoxin, sotalol, flecainide or a combination is used for transplacental treatment. The primary endpoint is disappearance of fetal tachyarrhythmias. The secondary endpoints are fetal death related to tachyarrhythmia, proportion of preterm birth, rate of caesarean section attributable to fetal arrhythmia, improvement in fetal hydrops, neonatal arrhythmia, neonatal central nervous system disorders and neonatal survival. Maternal, fetal and neonatal adverse events are evaluated at 1 month after birth. Growth and development are also evaluated at 18 and 36 months of corrected age.. The Institutional Review Board of the National Cerebral and Cardiovascular Center of Japan has approved this study. Our findings will be widely disseminated through conference presentations and peer-reviewed publications.. UMIN Clinical Trials Registry UMIN000004270.

Topics: Anti-Arrhythmia Agents; Atrial Flutter; Child Development; Child, Preschool; Digoxin; Drug Therapy, Combination; Echocardiography, Doppler; Female; Fetal Death; Fetal Diseases; Flecainide; Follow-Up Studies; Humans; Infant; Infant, Newborn; Japan; Male; Pregnancy; Prenatal Care; Prospective Studies; Research Design; Sotalol; Tachycardia, Supraventricular

Fetal tachyarrhythmia can lead to fetal hydrops due to heart failure. Flecainide is often considered as second-line therapy when digoxin monotherapy fails, which is more likely in hydropic fetuses. Time to conversion to sinus rhythm (SR) is critical in cases presenting with hydrops.. The aim of this study was to evaluate the efficacy and time to conversion to SR of transplacental treatment, especially flecainide.. This is a retrospective observational study of 46 fetuses with fetal tachyarrhythmia. Treatment was either flecainide (n = 28, 60.9%), digoxin+flecainide combination (n = 4, 8.7%), or digoxin (n = 10, 21.7%). In 4 fetuses (8.7%), no treatment was necessary.. In our study population, 26 of the 32 fetuses (81.2%) that were treated with flecainide as a first-line therapy (flecainide or digoxin+flecainide) converted to SR. The median time to conversion to SR was 3 days (range 1-7 days) with flecainide monotherapy and 11.5 days (range 3-14 days) with a combination therapy. Seventy-two percent (13/18) of hydropic fetuses and 90% (9/10) of nonhydropic fetuses converted to SR when treated with flecainide monotherapy. There was no statistical difference in rates of conversion to SR in hydropic and nonhydropic fetuses (P = .37) or time to conversion to SR in the 2 groups (P = .9). In the majority of the remaining fetuses, there was a partial response with decreased ventricular heart rates that were well tolerated.. Flecainide is highly effective in achieving SR in hydropic and nonhydropic fetuses with supraventricular tachycardia in a median time of 3 days. In our opinion, flecainide should be considered as first-line therapy in fetal supraventricular tachycardia with and without hydrops.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Female; Flecainide; Heart Rate, Fetal; Humans; Hydrops Fetalis; Pregnancy; Pregnancy Complications, Cardiovascular; Retrospective Studies; Tachycardia, Supraventricular; Treatment Outcome

Supraventricular tachycardia (SVT) is the most frequent form of symptomatic tachyarrhythmia in infants. The purposes of this study were to describe practice patterns of the management of infants hospitalized with SVT and factors associated with 30-day hospital readmission. This was a multi-institutional, retrospective review of the pediatric health information system database of SVT hospitalizations from 2003 to 2013. High-volume centers (HVC) were defined as those at the upper quartile of admissions. Infants with an ICD-9 code of paroxysmal SVT were included. Antiarrhythmics investigated included amiodarone, atenolol, digoxin, esmolol, flecainide, procainamide, propafenone, propranolol, and sotalol. Frequency of antiarrhythmic use based on center volume was the primary end point. Rate of 30-day SVT readmission was the secondary end point. Analysis of factors associated with readmission was assessed by Chi-square analysis and expressed as odds ratio and 95 % confidence interval. A total of 851 patients (60 % male, 44 % neonates) were hospitalized at 43 hospitals. Propranolol, digoxin, and amiodarone were the most frequently utilized antiarrhythmics. HVCs represented 12 hospitals comprising 494 (58 %) patients. Although HVCs were more likely to utilize propranolol (OR 2.5, CI 1.5-4.1), there was no significant difference in the 30-day readmission rate between patients treated at HVCs versus non-HVCs (p = 0.9). The majority of infants with SVT are treated with a small number of antiarrhythmic medications during index hospitalization. Although hospital-to-hospital variation in antiarrhythmic choice exists, there appears to be no difference in readmission. The remaining practice variation may be related to intrinsic patient characteristics.

Topics: Anti-Arrhythmia Agents; Digoxin; Female; Flecainide; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Tachycardia, Supraventricular

Topics: Anti-Arrhythmia Agents; Digoxin; Fetal Diseases; Flecainide; Humans; Tachycardia; Tachycardia, Supraventricular

The optimal treatment for fetal supraventricular tachycardia (SVT) with 1:1 atrioventricular relationship is unclear.. We compared the effectiveness of transplacental treatment protocols used in 2 centers.. Pharmacologic treatment was used in 84 fetuses. Maternal oral flecainide was the primary therapy in center 1 (n = 34) and intravenous maternal digoxin in center 2 (n = 50). SVT mechanism was classified by mechanical ventriculoatrial (VA) time intervals as short VA or long VA. Treatment success was defined as conversion to sinus rhythm (SR), or rate control, defined as >15% rate reduction.. Short VA interval occurred in 67 fetuses (80%) and long VA in 17 (20%). Hydrops was present 28 of 84 (33%). For short VA SVT, conversion to SR was 29 of 42 (69%) for digoxin and 24 of 25 (96%) for flecainide (P = .01). For long VA SVT, conversion to SR and rate control was 4 of 8 (50%) and 0 of 8, respectively, for digoxin, and 6 of 9 (67%) and 2 of 9 (cumulative 89%) for flecainide (P = .13). In nonhydropic fetuses, digoxin was successful in 23 of 29 (79%) and flecainide in 26 of 27 (96%) (P = .10). In hydrops, digoxin was successful in 8 of 21 (38%), flecainide alone in 6 of 7 (86%, P = .07 vs digoxin), and flecainide ± amiodarone in 7 of 7 (100%) (P = .01). Intrauterine or neonatal death occurred in 9 of 21 hydropic fetuses treated with digoxin (43%), compared to 0 of 7 (P = .06) treated with flecainide.. Flecainide was more effective than digoxin, especially when hydrops was present. No adverse fetal outcomes were attributed to flecainide.

Topics: Administration, Intravenous; Administration, Oral; Adult; Anti-Arrhythmia Agents; Clinical Protocols; Digoxin; Echocardiography; Edema; Female; Fetal Diseases; Fetal Therapies; Flecainide; Humans; Pregnancy; Retrospective Studies; Tachycardia, Supraventricular; Ultrasonography, Prenatal; Young Adult

Digoxin or propranolol are used as first-line enteral agents for treatment of infant supraventricular tachycardia. We used a large national database to determine whether enteral digoxin or propranolol was more efficacious as first-line infant supraventricular tachycardia therapy.. The Pediatric Health Information System database was queried over 10 years for infants with supraventricular tachycardia initiated on enteral digoxin or propranolol monotherapy. Patients were excluded for Wolff-Parkinson-White, intravenous antiarrhythmics (other than adenosine), or death. Success was considered as discharge on the initiated monotherapy. Risk factors for successful monotherapy and risk factors for readmission for supraventricular tachycardia for patients discharged on monotherapy were determined.. A total of 374 patients (59.6% male) met the study criteria. Median length of stay was 7 days (interquartile range of 3-16 days). Patients had CHD (n=199, 53.2%) and underwent cardiac surgery (n=123, 32.9%), ICU admission (n=238, 63.6%), mechanical ventilation (n=146, 39.0%), and extracorporeal membrane oxygenation (n=3, 0.8%). Pharmacotherapy initiation was at median 37 days of life (interquartile range of 12-127 days) and 47.3% were initiated on digoxin. Success was similar between digoxin (73.1%) and propranolol (73.5%). Initial therapy with digoxin was not associated with success (odds ratio 1.01, 95% CI 0.64-1.61, p=0.93). Multivariable analysis demonstrated hospital length of stay (odds ratio 0.98, 95% CI 0.98-1.00) and involvement of a paediatric cardiologist (odds ratio 0.46, 95% CI 0.29-0.75) associated with monotherapy failure, and male gender (odds ratio 1.66, 95% CI 1.03-2.67) associated with monotherapy success. No variables were significant for readmission on multivariable analysis.. Digoxin or propranolol may be equally efficacious for inpatient treatment of infant supraventricular tachycardia.

Topics: Anti-Arrhythmia Agents; Databases as Topic; Digoxin; Female; Heart Defects, Congenital; Hospitalization; Humans; Infant; Infant, Newborn; Male; Multivariate Analysis; Propranolol; Retrospective Studies; Risk Factors; Sex Factors; Tachycardia, Supraventricular; Treatment Outcome

Supraventricular tachycardia is uncommon in pregnancy. It is defined as intermittent pathological and usually narrow complex tachycardia >120 beats/min which originates above the ventricle, excluding atrial fibrillation, flutter and multifocal atrial tachycardia. It is usually self-limiting or relatively easily treated with most cases responding to physical or pharmacological therapies. We describe a case of a woman in the third trimester of pregnancy who developed treatment-resistant supraventricular tachycardia and required induction of labour and delivery to stop the arrhythmia. A multidisciplinary team approach with a critical care trained nurse and a midwife, continuous arterial blood pressure monitoring, transthoracic echocardiography, and neuraxial analgesia facilitated safe birth in the delivery suite and termination of the arrhythmia.

Topics: Adult; Amides; Amnion; Analgesia, Patient-Controlled; Analgesics, Opioid; Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthetics, Local; Anti-Arrhythmia Agents; Delivery, Obstetric; Digoxin; Dyspnea; Echocardiography; Fatigue; Female; Fentanyl; Flecainide; Humans; Labor, Obstetric; Metoprolol; Oximetry; Oxytocics; Oxytocin; Pregnancy; Pregnancy Complications, Cardiovascular; Ropivacaine; Tachycardia, Supraventricular

Supraventricular tachycardia is the most common arrhythmia in infants, and antiarrhythmic medications are frequently used for prophylaxis. The optimal prophylactic antiarrhythmic medication is unknown, and prior randomized trials have been underpowered. We used data from a large clinical registry to compare efficacy and safety of digoxin and propranolol for infant supraventricular tachycardia prophylaxis. We hypothesized that supraventricular tachycardia recurrence is less common on digoxin when compared with propranolol.. Retrospective cohort study.. Pediatrix Medical Group neonatal ICUs.. Infants discharged from 1998 to 2012 with supraventricular tachycardia who were treated with digoxin or propranolol. We excluded infants discharged before completing 2 days of therapy, those with Wolff-Parkinson-White syndrome, structural heart defects (except atrial/ventricular septal defects and patent ductus arteriosus), and those started on multidrug therapy.. We used Cox proportional hazards to evaluate supraventricular tachycardia recurrence, defined as need for adenosine or electrical cardioversion while exposed to digoxin versus propranolol, controlling for infant characteristics, inotropic support, supplemental oxygen, and presence of a central line. We identified 342 infants exposed to digoxin and 142 infants exposed to propranolol. The incidence rate of treatment failure was 6.7/1,000 infant-days of exposure to digoxin and 15.4/1,000 infant-days of exposure to propranolol. On multivariable analysis, treatment failure was higher on propranolol when compared with that on digoxin (hazard ratio, 1.97; 95% CI, 1.05-3.71). Hypotension was more frequent during exposure to digoxin versus propranolol (39.4 vs 11.1/1,000 infant-days; p < 0.001). There was no difference in frequency of other clinical adverse events.. Digoxin was associated with fewer episodes of supraventricular tachycardia recurrence but more frequent hypotension in hospitalized infants relative to propranolol.

Topics: Anti-Arrhythmia Agents; Digoxin; Electrocardiography; Female; Humans; Infant; Infant, Newborn; Male; Multivariate Analysis; Proportional Hazards Models; Propranolol; Retrospective Studies; Tachycardia, Supraventricular

We hereby describe a case report of a 9-month-old girl, who was accidentally intoxicated with digoxin since her parents by mistake gave her digoxin instead of propranolol. At admission sinusbradycardia and a first-degree atrioventricular block was found and she was treated with antidigitalis Fab-fragment and atropine. After three days of hospitalization she was discharged well-being. We suspect that the explanation for this intoxication is due to confusion of bottles of magistral preparations of medicine, as they were very identical. Therefore we call for increased attention in children receiving this type of medicine.

Topics: Accidents, Home; Anti-Arrhythmia Agents; Bradycardia; Digoxin; Female; Humans; Infant; Tachycardia, Supraventricular

Topics: Anti-Arrhythmia Agents; Digoxin; Female; Humans; Male; Propranolol; Tachycardia, Supraventricular

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Echocardiography; Female; Fetal Diseases; Flecainide; Heart Atria; Heart Defects, Congenital; Humans; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Prenatal

Fetal supraventricular tachycardia (SVT) is the most common form of fetal tachycardia. If started early in pregnancy, it can cause non-immune fetal hydrops. Echocardiography is the preferred method for the diagnosis with simultaneous pulsed Doppler recording from the superior vena cava and ascending aorta. Transplacental therapy with digoxin is the most common way of treatment. We present a case of fetal SVT detected at 26 weeks of pregnancy. Digoxin therapy restored the rhythm initially, but later paroxysms of fetal SVT persisted necessitating the addition of second antiarrhythmic medication which was discussed with the parents. The couple chose to proceed for premature delivery at 32 weeks.

Topics: Adult; Anti-Arrhythmia Agents; Cardiotocography; Cesarean Section; Digoxin; Echocardiography; Female; Fetal Diseases; Humans; Infant, Newborn; Pregnancy; Pregnancy Trimester, Second; Tachycardia, Supraventricular

We report the case of a 65-year-old woman presenting with recurrent vomiting for 3 days. She had been previously diagnosed with an atrial septal defect and was on treatment with diuretics and digoxin for paroxysmal supraventricular tachycardia. The clinical examination was consistent with an atrial septal defect with severe pulmonary hypertension. Electrocardiography showed complete heart block with ST-segment changes suggestive of digitalis toxicity. Transthoracic echocardiography confirmed Eisenmengerisation. Serum digoxin levels were elevated. Following hospitalisation, she was diagnosed with photophobia when she persistently asked for ambient lighting to be switched off. Most interestingly, the patient kept reporting seeing little yellow men, which was how she perceived the attending doctors. Cessation of digoxin therapy led to progressive abatement of her symptoms.

Topics: Aged; Anti-Arrhythmia Agents; Digoxin; Female; Humans; Photophobia; Tachycardia, Supraventricular; Vision Disorders

To evaluate the efficacy of flecainide and digoxin combination in foetal supraventricular tachycardia.. This study was carried out in a tertiary referral centre.. We conducted a retrospective review of 29 patients diagnosed with supraventricular foetal tachycardia between 2001 and 2009. Mode of presentation, foetal cardiac function, maternal anti-arrhythmic serum levels, drug tolerance, and maternal electrocardiogram recordings were assessed. The postnatal outcome of each infant was also evaluated for tachycardia recurrence.. In all, 27 foetuses were treated with digoxin and flecainide combination, and two foetuses were delivered without any treatment. Of the 27 foetuses treated, six [corrected] had atrial flutter and the remaining 21 [corrected] had atrioventricular re-entry tachycardia. There were eight foetuses with hydrops (27%), of whom three had atrial flutter and five had atrioventricular re-entry tachycardia; 26 foetuses (96%) responded to flecainide and digoxin combination, with restoration of sinus rhythm in 22 (81.4%) and rate control in the other four. In one severely hydropic foetus, there was no response to treatment. In all, 26 treated infants were delivered alive, but one pregnancy was terminated for non-cardiac causes when the foetus was in sinus rhythm. There was no intrauterine death due to tachycardia. Although there were minor side effects to anti-arrhythmic medications, none of the pregnant women developed proarrhythmia.. Flecainide and digoxin combination treatment offers a safe and effective treatment for foetal supraventricular tachycardia with fast restoration of sinus rhythm.

Topics: Adolescent; Adult; Anti-Arrhythmia Agents; Atrial Flutter; Digoxin; Drug Therapy, Combination; Echocardiography; Female; Fetal Diseases; Flecainide; Gestational Age; Humans; Hydrops Fetalis; Infant, Newborn; Pregnancy; Pregnancy Outcome; Retrospective Studies; Tachycardia, Atrioventricular Nodal Reentry; Tachycardia, Supraventricular; Treatment Outcome; Ultrasonography, Prenatal

Fetal supraventricular tachycardia (SVT) and atrial flutter (AF) can be associated with significant morbidity and mortality. 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. As an alternative to digoxin monotherapy, we have been using sotalol at presentation in fetuses with SVT or AF with, or at risk of, developing hydrops to attempt to achieve more rapid control of the arrhythmia. The present study was a retrospective review of the clinical, echocardiographic, and electrocardiographic data from all pregnancies with fetal tachycardia diagnosed and managed at a single center from 2004 to 2008. Of 29 affected pregnancies, 21 (16 SVT and 5 AF) were treated with sotalol at presentation, with or without concurrent administration of digoxin. Of the 21, 11 (6 SVT and 5 AF) had resolution of the tachycardia within 5 days (median 1). Six others showed some response (less frequent tachycardia, rate slowing, resolution of hydrops) without complete conversion. In 1 fetus with a slow response, the mother chose pregnancy termination. The 5 survivors with a slow response were all difficult to treat postnatally, including 1 requiring radiofrequency ablation as a neonate. One fetus developed blocked atrial extrasystoles after 1 dose of sotalol and was prematurely delivered for fetal bradycardia. Three grossly hydropic fetuses with SVT showed no response and died within 1 to 3 days of treatment. In conclusion, transplacental sotalol, alone or combined with digoxin, is effective for the treatment of fetal SVT and AF, with an 85% complete or partial response rate in our series.

Topics: Abortion, Induced; Anti-Arrhythmia Agents; Atrial Flutter; Bradycardia; Catheter Ablation; Digoxin; Drug Therapy, Combination; Electrocardiography; Female; Fetal Death; Fetal Diseases; Humans; Hydrops Fetalis; Infant, Newborn; Live Birth; Pregnancy; Premature Birth; Retrospective Studies; Sotalol; Tachycardia, Supraventricular

Topics: Anti-Arrhythmia Agents; Digoxin; Female; Humans; Male; Propranolol; Tachycardia, Supraventricular

Sustained fetal tachyarrhythmia may result in congestive heart failure, hydrops fetalis, and fetal/neonatal death, which requires timely and appropriate therapy.. To determine the value of transplacental digoxin therapy for fetal tachyarrhythmia with multiple evaluations.. Four cases of fetal tachyarrhythmia were diagnosed with fetal echocardiography and treated with transplacental digoxin therapy with an initial dosage of 0.25 mg qd. Fetal echocardiography and measurement of maternal serum digoxin concentrations were performed every 5-7 days. Echocardiographic information was further used for the calculation of three evaluation systems including, Tei index, cardiovascular profile score (CVPS), and umbilical artery resistance index (UARI). The dosage of digoxin was adjusted according to the serum concentration, as well as results from three evaluation systems.. During the course of digoxin treatment, our patients show an increase of CVPS and decrease of Tei index and UARI, suggesting the recovery of heart function. Sinus rhythm was restored in 3-10 days in three cases and 42 days in one case. At the time of delivery, the placental transportation efficiency (neonate/mother ratio of serum digoxin concentration) was 76.45-84.31%. Following delivery, the general conditions of neonates were favorable. During the 4- to 14-month follow-up, reoccurrence of arrhythmia, neurological deficit, and retarded growth and development were not observed.. Transplacental digoxin therapy with combined evaluation of Tei index, CVPS, and UARI systems is useful for treating fetal atrial flutter (AF) and supraventricular tachycardia (SVT).

Topics: Anti-Arrhythmia Agents; Atrial Flutter; Digoxin; Echocardiography; Female; Fetal Diseases; Fetal Monitoring; Fetal Movement; Gestational Age; Heart Rate, Fetal; Humans; Maternal-Fetal Exchange; Pregnancy; Tachycardia; Tachycardia, Supraventricular

Fetal tachyarrhythmia may result in low cardiac output and death. Consequently, antiarrhythmic treatment is offered in most affected pregnancies. We compared 3 drugs commonly used to control supraventricular tachycardia (SVT) and atrial flutter (AF).. We reviewed 159 consecutive referrals with fetal SVT (n=114) and AF (n=45). Of these, 75 fetuses with SVT and 36 with AF were treated nonrandomly with transplacental flecainide (n=35), sotalol (n=52), or digoxin (n=24) as a first-line agent. Prenatal treatment failure was associated with an incessant versus intermittent arrhythmia pattern (n=85; hazard ratio [HR]=3.1; P<0.001) and, for SVT, with fetal hydrops (n=28; HR=1.8; P=0.04). Atrial flutter had a lower rate of conversion to sinus rhythm before delivery than SVT (HR=2.0; P=0.005). Cardioversion at 5 and 10 days occurred in 50% and 63% of treated SVT cases, respectively, but in only 25% and 41% of treated AF cases. Sotalol was associated with higher rates of prenatal AF termination than digoxin (HR=5.4; P=0.05) or flecainide (HR=7.4; P=0.03). If incessant AF/SVT persisted to day 5 (n=45), median ventricular rates declined more with flecainide (-22%) and digoxin (-13%) than with sotalol (-5%; P<0.001). Flecainide (HR=2.1; P=0.02) and digoxin (HR=2.9; P=0.01) were also associated with a higher rate of conversion of fetal SVT to a normal rhythm over time. No serious drug-related adverse events were observed, but arrhythmia-related mortality was 5%.. Flecainide and digoxin were superior to sotalol in converting SVT to a normal rhythm and in slowing both AF and SVT to better-tolerated ventricular rates and therefore might be considered first to treat significant fetal tachyarrhythmia.

Topics: Anti-Arrhythmia Agents; Digoxin; Drug Evaluation; Female; Fetal Diseases; Fetal Therapies; Flecainide; Humans; Pregnancy; Retrospective Studies; Sotalol; Tachycardia, Supraventricular; Treatment Outcome

The purpose of this study was to report the efficacy of intravenous amiodarone alone or in combination with digoxin in neonates and small infants with life-threatening supraventricular tachyarrhythmia (SVT).. We retrospectively analyzed 9 neonates and small infants with life-threatening or resistant SVT who were treated with intravenous amiodarone alone or in combination with digoxin.. This report consists of 8 patients with reentrant SVT and 1 with atrial flutter. On admission, 7 patients had a congestive heart failure and 3 of whom had cardiovascular collapse. Intravenous rapid bolus of adenosine caused a sustained sinus rhythm in 4 patients. These patients were given digoxin initially, but recurrence of persistent tachyarrhythmia necessitated the use of intravenous amiodarone in all these patients. Amiodarone was given initially to the other 4 patients in whom adenosine caused only temporary conversion to the sinus rhythm. It was effective in 2 patients. In the other 2, digoxin was added to therapy for tachycardia control. Amiodarone alone or in combination with digoxin effectively controlled reentrant SVT in all patients. This combined treatment caused ventricular rate control in patient with atrial flutter, and conversion to the stable sinus rhythm was achieved at approximately 8 months.. Intravenous amiodarone alone or in combination with digoxin was found to be safe and effective in controlling refractory and life-threatening SVT in neonates and small infants.

Topics: Adenosine; Amiodarone; Anti-Arrhythmia Agents; Atrial Flutter; Digoxin; Drug Evaluation; Drug Therapy, Combination; Electrocardiography, Ambulatory; Female; Follow-Up Studies; Heart Defects, Congenital; Heart Failure; Heart Neoplasms; Heart Rate; Humans; Hypotension; Infant; Infant, Newborn; Infusions, Intravenous; Injections, Intravenous; Male; Retrospective Studies; Rhabdomyoma; Shock, Cardiogenic; Tachycardia, Supraventricular; Thyrotropin; Treatment Outcome

Topics: Accessory Atrioventricular Bundle; Adult; Catheter Ablation; Digoxin; Electrocardiography; Flecainide; Humans; Male; Postoperative Complications; Tachycardia, Supraventricular; Ventricular Premature Complexes

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Female; Fetal Diseases; Hemodynamics; Humans; Pregnancy; Tachycardia, Supraventricular; Tricuspid Valve Insufficiency; Twins; Ultrasonography, Prenatal

Neonatal survival and prognosis are closely linked with development of hydrops in cases of sustained fetal tachycardia. Several antiarrhythmic medications are available for conversion to sinus rhythm.. An 18-year-old woman had an audible fetal arrhythmia at 25 weeks' gestation. Fetal echocardiography revealed supraventricular tachycardia with worsening cardiac function at 28 weeks. Digoxin therapy was initiated and sotalol was later added for new-onset hydrops. The medications were then adjusted, and the fetus' heart rate converted to sinus rhythm with resolution of the hydrops. The patient was then managed as an outpatient with antenatal testing, serial laboratory studies and electrocardiograms until 39 weeks.. Digoxin and sotalol therapy can be successful in blocking likely nodal reentry in sustained fetal supraventricular tachycardia, thus allowing resolution of hydrops with a favorable outcome.

Topics: Adolescent; Anti-Arrhythmia Agents; Digoxin; Female; Fetal Therapies; Humans; Hydrops Fetalis; Pregnancy; Sotalol; Tachycardia, Supraventricular; Treatment Outcome; Ultrasonography, Prenatal

Topics: Anti-Arrhythmia Agents; Ascites; Digoxin; Echocardiography; Female; Fetal Diseases; Humans; Hydrops Fetalis; Pregnancy; Pregnancy Complications, Cardiovascular; Tachycardia, Supraventricular

Supraventricular tachycardia (SVT) is the second most frequent form of arrhythmia in pediatrics after extrasystole.. 1. To determine the clinical characteristics and treatment of SVT in infants and children. 2. To determine treatment response and the drugs used.. A retrospective review of 61 cases of SVT requiring PICU admission (1999-2004) was performed. PICU admission was due to persistent SVT after vagal maneuvers.. There were 61 patients and 39 were boys (63.9%). The mean age was 2.1 years (SD +/- 3.1). Twelve patients had congenital heart disease (19.7%); three (4.9%) were admitted after heart surgery, and the remaining patients had no antecedents (60.7%). The mean cardiac frequency was 238 beats/min (SD +/- 42.86). Heart failure (HF) was observed in 14 patients (23%). Statistically significant differences were found between the presence of HF and time since onset (p < 0.01) and younger age (p < 0.01). The most frequent diagnosis was SVT due to re-entry in 28 patients (45.9%). Medical treatment was required in 46 patients (75.4%) and response was achieved in 35 (57.4%). At crisis the first drug used was adenosine triphosphate (ATP) in 35 patients (61.4%) with good response in 21 (36.8%). As maintenance therapy digoxin was used in 29 patients (50.9%) without relapses in 22 (78.6%). Radiofrequency ablation was required in 17 patients (27.9%), and there were three relapses (17.6%). The ages of patients who underwent ablation ranged from 3.5 days to 13 years.. 1. HF was observed mainly in infants. 2. Most of the patients had good response to ATP therapy. 3. Radiofrequency ablation was mainly required in patients aged more than 1 year.

Topics: Adenosine Triphosphate; Adolescent; Age Factors; Anti-Arrhythmia Agents; Cardiotonic Agents; Catheter Ablation; Child; Child, Preschool; Data Interpretation, Statistical; Digoxin; Female; Heart Defects, Congenital; Heart Failure; Heart Rate; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Sex Factors; Tachycardia, Supraventricular; Treatment Outcome

Persistent fetal supraventricular tachycardia (SVT) with more than 210 bpm frequently leads to congestive heart failure. We report on a case with SVT and congestive heart failure that converted into sinus rhythm within 19 days of therapy with flecainide and beta-acetyldigoxin. A 32-year-old II gravida I para (25 + 1 weeks of gestation) presented with fetal SVT of 267 bpm. A non-immunologic hydrops fetalis was diagnosed by ultrasound showing ascites, pleural and pericardial effusion and tricuspid regurgitation. Within 19 days of combination therapy with flecainide and digoxin, cardioversion was achieved. After 36 days of therapy no more signs of cardiac failure could be detected. A healthy boy was born at 38 + 6 weeks of gestation. Although cardioversion is expected after 72 h of therapy according to the literature, this fetus converted into sinus rhythm on day 19 of therapy. This indicates that patients should not be considered resistant to treatment within the first 3 - 4 days.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Drug Combinations; Female; Fetal Distress; Flecainide; Humans; Pregnancy; Pregnancy Trimester, Third; Tachycardia, Supraventricular; Treatment Outcome; Ultrasonography

A case of a twin pregnancy in which one fetus developed hydrops secondary to supraventricular tachycardia was detected at 21 weeks' gestation. Transplacental digoxin therapy successfully converted the supraventricular tachycardia to a normal sinus rhythm without evidence of maternal or fetal side-effects. The pregnancy proceeded to term and elective cesarean section was carried out at 37 weeks' gestation.

Topics: Adult; Cesarean Section; Digoxin; Diseases in Twins; Fatal Outcome; Female; Fetal Diseases; Gestational Age; Humans; Hydrops Fetalis; Male; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Tachycardia, Supraventricular; Ultrasonography, Prenatal

The aim is to emphasize the importance of extracardiac symptoms of digoxin intoxication in newborns. The most common intoxication symptoms in adults are of cardiac origin, but due to altered symptomatology, digoxin overdose in infants are not always discovered on symptomatic basis. In preterm infants, this is even more pronounced due to diminished digoxin sensitivity. Also, tissue distribution is altered in newborns, which, combined with the need for higher doses in newborns to obtain clinical effect, underscores the need for the utmost care, when newborns receive digoxin treatment to avoid intoxication. We report a case of severe digoxin intoxication in a preterm newborn infant, leading to distinct gastrointestinal symptoms, but only minor cardiac affection. The literature concerning digoxin intoxication and digoxin measurement is reviewed to elucidate the case report. In conclusion, alertness should be drawn to extracardiac symptoms of digoxin intoxication, especially in newborns, and P-Potassium can serve as a predictor and thereby strengthen any given suspicion. Therapeutic drug monitoring should be performed, as soon as digoxin overdose due to the above-mentioned signs is suspected in spite of vague cardiac symptoms.

Topics: Abdominal Pain; Anti-Arrhythmia Agents; Digoxin; Enterocolitis, Necrotizing; Gastrointestinal Tract; Humans; Infant, Newborn; Infant, Premature; Male; Nausea; Tachycardia, Supraventricular; Vomiting

A case is reported of a middle-aged female with congenital heart disease who presented with treatment-resistant supraventricular tachycardia. Supraventricular tachycardias (SVTs) in congenital heart disease (and their management) are discussed. The authors are not aware of any similar reports in the literature.

Topics: Adenosine; Amiodarone; Anti-Arrhythmia Agents; Digoxin; Ebstein Anomaly; Electric Countershock; Female; Humans; Middle Aged; Tachycardia, Supraventricular; Treatment Outcome

Fetal arrhythmia is an unusual cause of admission in critical care unit. We report three cases of pregnant patients with gestational age of 27 to 32 weeks, with diagnosis of fetal sustained supraventricular tachyarrhymias; which were resistant to digoxin as first line therapy. Two fetuses had supraventricular tachycardia and were converted with flecainide in association with digoxin. A remaining hydropic fetus suffering atrial flutter with 2:1 auriculo-ventricular conduction, failed to restore sinus rhythm with digoxin alone or in association with flecainide nor amiodarone, and required premature c-section at 30a week of gestation. Due to amiodarone administration the neonate suffered transient neonatal hypothyroidism.

Topics: Adult; Amiodarone; Anti-Arrhythmia Agents; Digoxin; Female; Fetal Diseases; Flecainide; Humans; Male; Pregnancy; Tachycardia, Supraventricular; Treatment Outcome; Ultrasonography

Fetal supraventricular tachycardia confers an increased risk of cardiac failure, hydrops, and eventual intrauterine death. Although protocols for prenatal anti-arrhythmic treatment are now well established, few published reports discuss this condition in the setting of multiple pregnancies.. A 20-year-old primigravida woman with a twin pregnancy presented at 31 weeks of gestation for routine obstetrical check-up which revealed simultaneous supraventricular tachycardia in both fetuses. She was treated with oral digoxin, resulting in successful cardioversion in both of the fetuses, which was maintained until they were delivered by caesarian section at 38 weeks gestation. However, several hours after birth, tachyarrhythmias recurred in each of the infants. Combined disopyramide therapy with digoxin was necessary to control their heart rates.. The treatment of arrhythmia in fetuses of a multiple gestation presents unique issues, particularly when diagnosed prior to fetal lung maturity.

Topics: Administration, Oral; Adult; Anti-Arrhythmia Agents; Digoxin; Disopyramide; Drug Therapy, Combination; Female; Fetal Diseases; Heart Rate; Humans; Infant, Newborn; Pregnancy; Pregnancy, Multiple; Recurrence; Tachycardia, Supraventricular; Twins

Supraventricular tachycardia is the most common clinically significant fetal tachycardia. The diagnosis is usually made at routine sonographic workup during the second-third trimester of pregnancy. Treatment goals are cardioversion to sinus rhythm and reversal of cardiac dysfunction. We describe a case of fetal supraventricular tachycardia diagnosed at 24 weeks of gestation. The first-line treatment was oral maternal digoxin and sotalol. This therapy was not sufficient for complete control of the tachycardia. Hence, second-line treatment with digoxin and flecainide was started and successfully achieved conversion to sinus rhythm. No adverse maternal side effects were noted during the 14 weeks of therapy. A normal male infant was delivered at elective cesarean section performed for obstetric indications at 38 weeks of gestation. A persistent junctional reciprocating tachycardia with a ventriculo-atrial/atrioventricular ratio > 1 was diagnosed following delivery at transesophageal electrophysiological study. At the age of 8 months the child is on therapy with sotalol (4 mg/kg/day) and flecainide (3 mg/kg/day) and is in good clinical conditions.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Female; Fetal Distress; Flecainide; Gestational Age; Humans; Maternal-Fetal Exchange; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Sotalol; Tachycardia, Supraventricular; Ultrasonography, Prenatal

Fetal tachycardia may lead to an increased pre- and postnatal morbidity and mortality rate particularly if it is complicated by cardial decompensation and hydrops fetalis.. In this study 33 fetal tachycardia cases diagnosed and treated between 1993 and 2004 in the fetal echocardiography unit of the I. Department of Obstetrics and Gynecology of the Semmelweis University, Budapest are reviewed. The data of postnatal care of the newborns delivered in the author's department from these pregnancies, and the follow up data provided by the National Institute of Cardiology are examined as well.. Mean gestational age at diagnosis of fetal tachycardia was 30 weeks (21-41 weeks). The tachyarrhythmias were classified into atrial flutter (n = 8), supraventricular tachycardia (n = 18), arrhythmia absoluta (n = 5), parasystole (n = 1) and brady-tachyarrhythmia (n = 1). Six cases were complicated by hydrops fetalis, 13 cases by cardial dysfunction. Transplacental antiarrhythmic therapy was applied in 22 cases, in 8 cases the newborns were delivered because of advanced gestational age, in 3 cases tachyarrhythmia resolved spontaneously or therapy was not indicated. The drug of first choice for transplacental therapy was digoxin, which was combined with amiodarone or verapamil (n = 10). Transplacental therapy led to cardioversion in 13/22 cases. The outcome of the 33 examined pregnancies was live birth in 27 cases, in utero death in 3 cases and 3 newborns were delivered elsewhere. The postnatal documentation of 24 newborns out of the 27 born in the author's department is available. At the time of birth 15/24 newborns were in sinus rhythm--out of whom 5 developed tachyarrhythmia later during the neonatal period--, 9/24 were tachycardic. Out of the 14 cases of tachyarrhythmia detected in the neonatal period altogether 3 resolved spontaneously, in 7 cases antiarrhythmic therapy was successful, in 4 cases unsuccessful. In 2 of these latter cases electrical cardioversion led to sinus rhythm. Neurological disorder was not detected in any case. In the early postnatal period 2 in utero severely decompensated newborns died. The follow-up data of 10 children is available, the follow-up period ranges between 6 weeks and 5 and a half years. All 5 children with history of supraventricular tachycardia are in sinus rhythm, 3 of them after suspending antiarrhythmic treatment, while the other 2 still on antiarrhythmic medication. Four out of 5 children with history of atrial flutter are in sinus rhythm, 2 of them left antiarrhythmic therapy, and 2 of them still take antiarrhythmic agents after electrical cardioversion. The atrial flutter of a 3 month old child could not be controlled yet permanently, despite several drug combinations applied.. Survival and late prognosis of tachycardic fetuses treated in utero is good. A prospective study of even more cases is required to establish uniform therapeutic guidelines and to provide appropriate follow-up data.

Topics: Amiodarone; Anti-Arrhythmia Agents; Digoxin; Electric Countershock; Female; Fetal Diseases; Follow-Up Studies; Gestational Age; Hemodynamics; Humans; Male; Retrospective Studies; Tachycardia; Tachycardia, Supraventricular; Verapamil

The aim of this study was to evaluate the role of amiodarone for the prenatal treatment of hydropic fetuses with supraventricular tachycardia.. A group of 26 hydropic fetuses with supraventricular tachycardia was studied retrospectively.. Twenty-five fetuses received transplacental treatment. The overall prenatal conversion rate was 60%. Nine fetuses were converted to sinus rhythm using either flecainide (n = 7) or amiodarone (n = 2) as first line therapy, whilst digoxin alone or in association with sotalol failed to restore sinus rhythm in all cases. After first-line therapy, supraventricular tachycardia persisted in 10 fetuses. Nine fetuses received amiodarone alone or in association with digoxin as second-line therapy, five of whom were converted to sinus rhythm. Among the 11 live neonates treated by amiodarone in utero, 2 (17%) presented an elevated thyroid stimulating hormone at day 3-4. These two infants received thyroid hormone substitution therapy and had a normal outcome.. When first-line therapy fails to restore sinus rhythm in hydropic fetuses with supraventricular tachycardia, amiodarone therapy should be considered as it allows a substantial number of fetuses to be converted prenatally.

Topics: Amiodarone; Anti-Arrhythmia Agents; Digoxin; Drug Therapy, Combination; Flecainide; Hydrops Fetalis; Retrospective Studies; Tachycardia, Supraventricular; Treatment Outcome

Supraventricular tachycardia (SVT) is the most commonly encountered clinically significant tachycardia in the fetus. When SVT is sustained, congestive heart failure and fetal hydrops may ensue, due to both systolic and diastolic dysfunction. Sonographic diagnosis is usually incidental during the second or third trimester. Treatment goals are cardioversion to sinus rhythm and reversal of cardiac dysfunction. We describe a case of fetal SVT diagnosed at 13 weeks of gestation. Treatment with digoxin and flecainide was successful; the heart rate returned to sinus rhythm within one day, and fetal hydrops resolved within 8 days of treatment. We suspect that as more first-trimester examinations are performed, more cases with SVT will be diagnosed. We discuss the treatment protocol, and suggest that co-administration of two drugs that act synergistically may be more efficient than monotherapy, which is currently used as the first line of treatment. In addition, we discuss the potentially deleterious effect of heart failure encountered at an early developmental stage on the central nervous system. More data need to be collected in order to substantiate a clear recommendation regarding optimal management.

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Female; Flecainide; Gestational Age; Humans; Hydrops Fetalis; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Doppler

To describe the prenatal management and outcome of a series of 66 fetuses with supraventricular tachycardia (SVT).. The perinatal data of 66 fetuses with SVT were retrospectively studied from January 1990 to December 2000. Junctional tachycardia was found in 50 fetuses and atrial flutter was found in 16 fetuses. Two groups were studied depending on the absence (n=40) or the presence of hydrops (n=26) at the time of the diagnosis. All fetuses but one were treated prenatally via the mother. Anti-arrhythmic drugs used were: digoxin, sotalol, flecainide or amiodarone.. Group of fetuses with no hydrops: digoxin was used in 32 cases and allowed 26 fetuses to be converted to sinus rhythm (80%). One intra uterine death (IUD) occurred in this group. Hydropic fetuses group: nine fetuses were converted to sinus rhythm using either flecainide (n=7) or amiodarone (n=2) as first line therapy, whilst digoxin alone or in association with sotalol failed to restore sinus rhythm in all cases. After first line therapy, SVT persisted in 10 fetuses. Nine fetuses received amiodarone alone or in association with digoxin as second line therapy, five of whom were converted to sinus rhythm. Among the 18 alive neonates treated by amiodarone in utero, three presented elevated thyroid stimulating hormone at day 3-4 and required thyroid hormonal substitution therapy for 2-6 months with normal outcome.

Topics: Amiodarone; Anti-Arrhythmia Agents; Atrial Flutter; Clinical Protocols; Digoxin; Echocardiography; Female; Fetal Diseases; Flecainide; Gestational Age; Heart Rate, Fetal; Humans; Hydrops Fetalis; Infant, Newborn; Pregnancy; Pregnancy Outcome; Prenatal Care; Retrospective Studies; Sotalol; Tachycardia, Ectopic Junctional; Tachycardia, Supraventricular; Treatment Outcome; Ultrasonography, Prenatal

To review the diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia.. Retrospective review of published reports: 11 papers about fetal tachyarrhythmia published between 1991 and 2002 were selected for review.. All selected studies were analysed for the type of arrhythmia, degree of atrioventricular block in atrial flutter, occurrence of hydrops fetalis, gestational age at diagnosis, first and second line drug treatment, associated cardiac and extracardiac malformations, and mortality of the fetuses.. Atrial flutter accounted for 26.2% of all cases of fetal tachyarrhythmias, and supraventricular tachycardia for 73.2%. Hydrops fetalis was reported in 38.6% and 40.5% of fetuses with atrial flutter and supraventricular tachycardia, respectively (NS). Hydropic fetuses with atrial flutter had higher ventricular rates (median 240 beats/min, range 240-300) than non-hydropic fetuses (220 beats/min, range 200-310) (p = 0.02), whereas the atrial rates were not significantly different (median 450 beats/min, range 370-500). Digoxin treatment resulted in a higher conversion rate in non-hydropic fetuses with fetal tachyarrhythmias than in hydropic fetuses (p < 0.001). The overall mortality of atrial flutter was similar to that of supraventricular tachycardia, at 8.0% v 8.9% (p = 0.7).. The prevalence of hydrops fetalis did not differ in fetal atrial flutter and supraventricular tachycardia with 1:1 conduction. There was no difference between the response rate to digoxin in fetus with atrial flutter or supraventricular tachycardia. Mortality was similar in the two types of tachyarrhythmia.

Topics: Anti-Arrhythmia Agents; Atrial Flutter; Digoxin; Fetal Diseases; Heart Block; Heart Defects, Congenital; Humans; Hydrops Fetalis; Postnatal Care; Prenatal Care; Prenatal Diagnosis; Prognosis; Tachycardia, Supraventricular

Approximately 60% of children with supraventricular tachycardia (SVT) develop their initial episode by 1 year of age. Despite resolution in most of these patients by 1 year, approximately 30% of the SVT will recur. We performed a retrospective review of all patients <1 year of age with SVT between January 1984 and December 2000. Recurrence was defined as documented SVT at >1 year of age. Patients were divided into: (1) a first line (FL) group (controlled with digoxin and/or propranolol) and (2) a second line (SL) group (requiring additional antiarrhythmics). The groups were divided based on the presence of preexcitation. The FL group included 116 patients, 20 of whom (17%) had Wolff-Parkinson-White (WPW) syndrome. The SL group included 34 patients, 21 of whom (62%) had WPW (p <0.001). Recurrence of SVT occurred in 32 patients (28%) in the FL group and in 23 patients (68%) in the SL group (p <0.001). SVT recurred in 36 of 41 patients (88%) with WPW compared with 19 of 109 patients (17%) without WPW syndrome (p <0.001). Logistic regression analysis demonstrated that the presence of WPW syndrome was associated with a 29-fold higher odds of SVT recurrence (p <0.001), and that patients with WPW syndrome were more likely to require additional antiarrhythmic therapy (p <0.001). Thus, patients with WPW syndrome who had SVT at <1 year of age have 29-fold higher odds of recurrence at >1 year of age versus those patients with preexcitation. These patients are also more likely to require additional antiarrhythmic therapy to control SVT. Furthermore, children with WPW syndrome who are refractory to treatment with digoxin and/or propranolol are at increased risk of SVT recurrence.

Topics: Age of Onset; Anti-Arrhythmia Agents; Digoxin; Female; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Pre-Excitation Syndromes; Predictive Value of Tests; Propranolol; Recurrence; Retrospective Studies; Risk Factors; Sex Factors; Tachycardia, Supraventricular

To assess the efficacy of flecainide in the intrauterine treatment of fetal supraventricular tachycardia (SVT) with 1 : 1 atrioventricular conduction.. Twenty fetuses (21-35 weeks of gestation) with SVT ranging between 215 and 280 bpm were analyzed retrospectively. Fetuses received flecainide and digoxin as either first, second or third line therapy. Intracardiac blood flow, venous Doppler waveforms and cardiotocograms were evaluated before and after drug induced conversion to sinus rhythm.. After initiation of combined flecainide and digoxin therapy, the median time interval until final conversion to sinus rhythm was 5 days (range, 0-14 days). The majority of fetuses (n = 15; 75%) converted to sinus rhythm within 7 days of treatment, whereas the remaining five (25%) showed initial reduction of the heart rate to 160-215 bpm over several days, with restoration of a triphasic venous blood flow pattern before late conversion within 7-14 days after initiation of flecainide treatment. One of these fetuses showed a decrease in fetal heart rate to 160-190 bpm without conversion to sinus rhythm but with resolution of hydrops. All fetuses survived.. Flecainide is safe and highly effective in the intrauterine treatment of hydropic fetuses with supraventricular tachycardia. Conversion into sinus rhythm can be expected 72 h after initiation of therapy but may take up to 14 days. Therefore therapy should be continued beyond 72 h, especially when an initial decrease of fetal heart rate is observed which may represent an early therapeutic response.

Topics: Anti-Arrhythmia Agents; Cardiotocography; Digoxin; Female; Fetal Diseases; Flecainide; Humans; Hydrops Fetalis; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Doppler; Ultrasonography, Prenatal

As outpatients with long-term chronic illness often show a high incidence of medication noncompliance, we investigated the influence of digoxin noncompliance on hospitalization, left ventricular ejection fraction, and mortality in outpatients in long-term therapy having congestive heart failure with tachycardia at a rate over 100 beats/min before starting digoxin therapy, but abnormal sinus rhythm.. Before starting this study, the digoxin compliance/noncompliance of patients was determined by measuring the serum digoxin concentration (SDC). SDC was determined once a month, followed for six consecutive months, and patients were defined as noncompliant if their SDC was zero (0.0 ng/ml) on at least three consecutive occasions. According to SDC data, 218 patients were assigned to the compliant group and 213 patients were assigned to the noncompliant group. All 431 patients received diuretics, angiotensin converting-enzyme inhibitors, or nitrates as well as conventional therapy with digoxin throughout the trial. The duration of follow-up was 72 months.. After 72 months of follow-up, the digoxin noncompliant patients showed significant increases in the number and duration of hospitalizations compared with the compliant patients. The digoxin noncompliant patients had a marked decrease in the left ventricular ejection fraction from 49.1% to 41.8%. The cumulative rate of mortality from any cause in noncompliant patients was twofold higher (15.0%) than in compliant patients (7.8%; risk ratio when noncompliant was compared with compliant: 1.95; 95% confidence interval 1.11, 3.45; P = 0.029) at the 72-month follow-up. The higher mortality in digoxin noncompliant patients was exclusively attributed to worsening heart failure rather than other cardiac and noncardiac causes (risk ratio 2.13; 95% confidence interval 1.12, 4.07; P = 0.033). In addition, multiple regression analyses demonstrated that patient noncompliance as well as lower left ventricular ejection fraction at baseline were significantly involved in increased mortality.. These results indicate that digoxin noncompliance, at least in part, increases the rate of both hospitalization and mortality due to worsening heart failure in outpatients who have congestive heart failure with tachycardia in long-term therapy.

Topics: Aged; Analysis of Variance; Cardiotonic Agents; Confidence Intervals; Digoxin; Female; Heart Failure; Hospitalization; Humans; Linear Models; Male; Middle Aged; Odds Ratio; Prospective Studies; Regression Analysis; Tachycardia, Supraventricular; Treatment Refusal; Ventricular Dysfunction, Left

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Female; Fetal Diseases; Fetal Heart; Heart Rate, Fetal; Humans; Hydrops Fetalis; Maternal-Fetal Exchange; Pregnancy; Tachycardia, Supraventricular; Ultrasonography

This study investigated the association of COPD and postoperative cardiac arrhythmias, specifically supraventricular tachycardia (SVT), as well as mortality in patients undergoing pulmonary resection for non-small cell lung cancer (NSCLC).. A retrospective chart review of 244 patients who had undergone lung resection for NSCLC at Indiana University Hospital between 1992 and 1997 was undertaken. COPD, which was defined as an FEV(1) of < or = 70% predicted and an FEV(1)/FVC ratio of < or = 70% based on the results of a preoperative pulmonary function test (PFT), was diagnosed in 78 of the 244 patients (COPD group). In the remaining 166 patients, the results of preoperative PFTs did not meet these criteria (non-COPD group). Both groups were otherwise well-matched with respect to multiple variables, including age, comorbid conditions, extent of pulmonary resection, and final pathologic stage. The incidence of cardiac arrhythmias and operative mortality were compared between the two groups using univariate and multivariate analysis.. Seventy-six patients (31.9%) experienced new onsets of postoperative SVT, with 58 of these patients (76.3%) demonstrating atrial fibrillation. The COPD group had a 58.7% incidence of SVT (n = 44) compared to a 27.0% incidence (n = 44) in the non-COPD group (p < 0.0 0 1). Moreover, following initial digoxin therapy, the COPD group required more second-line antiarrhythmic therapy than did the non-COPD group (66.7% vs 37.8%, respectively; p = 0.0 03). Overall, there were 16 operative deaths (6.6%), and the mortality rate was significantly higher in the COPD group (14.1%) than in the non-COPD group (3.0%; p = 0.0 04). Patients who developed SVT had a significantly longer hospital course than did patients who did not (p < 0.0001). Thirteen of the 16 patients who died experienced SVT; however, SVT was not an independent risk factor for death. Finally, of the 19 variables evaluated, major resection (ie, pneumonectomy and bilobectomy) and COPD were identified as independent risk factors for the development of cardiac arrhythmias (p = 0.0 033 and p = 0.0 009, respectively).. Patients with COPD, as defined by the results of preoperative PFTs, are at significantly higher risk for SVT, and in particular SVT refractory to digoxin, following pulmonary resection for NSCLC. Although SVT was not an independent risk factor for death, a significantly longer hospitalization was observed.

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Carcinoma, Non-Small-Cell Lung; Cause of Death; Digoxin; Female; Forced Expiratory Volume; Hospital Mortality; Humans; Lung Neoplasms; Male; Middle Aged; Pneumonectomy; Postoperative Complications; Pulmonary Disease, Chronic Obstructive; Risk Factors; Survival Rate; Tachycardia, Supraventricular; Vital Capacity

This is the report of a case of fetal tachyarrhythmia with 1:1 atrioventricular conduction detected by pre-natal echocardiography in a fetus at 25-weeks gestation. Adenosine infusion via cordocentesis was performed as a diagnostic test to differentiate between atrioventricular nodal reentrant supraventricular tachyarrhythmia and atrial flutter. After infusion, transient 2:1 atrioventricular dissociation was obtained and the diagnosis of atrial flutter was made. Transplacental therapy with digoxin and amiodarone was then successfully used.

Topics: Adenosine; Adult; Anti-Arrhythmia Agents; Digoxin; Female; Fetal Diseases; Humans; Injections, Intravenous; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Prenatal; Umbilical Veins

Clinical observations suggest that flecainide might pass the placenta more easily than digoxin, and that its transfer is less disturbed in case of hydrops fetalis than that of digoxin. The purpose of the study was to compare the materno-fetal transplacental transfer of digoxin, flecainide, and amiodarone, another antiarrhythmic agent used in the treatment of fetal tachyarrhythmia, and to assess the effect of an elevated umbilical venous pressure (UVP) on the transfer rate. Isolated lobules of 16 human placentas were dually perfused after spontaneous delivery or caesarean section. The transplacental transfer (area under the curve in the maternal compartment [maternal AUC], area under the curve in the fetal compartment [fetal AUC], kinetic parameters) of digoxin, flecainide, and amiodarone was calculated after these drugs were added to the maternal circuit. In five experiments, the effect of increased UVP on the transplacental transfer rate was assessed by elevating the UVP by 10 cm H2O. Flecainide efflux out of the maternal compartment was significantly greater than that of digoxin (maternal AUC 57.4% +/- 5.1 %/min vs 73.9% +/- 1.5%/min), whereas the flecainide influx into the fetal circulation was smaller (fetal AUC 9.3% +/- 4.1%/min vs 11.5% +/- 2.0%/min). Only in 50% of the experiments were the smallest amounts of amiodarone detectable in the fetal compartment. An elevation of the UVP reduced the influx of digoxin and flecainide into the fetal compartment (fetal AUC) from 11.5% +/- 2.0%/min to 7.4% +/- 1.9%/min and from 9.3% +/- 4.1% to 4.7% +/- 1.4%/min, respectively. Materno-fetal transplacental transfer of digoxin, flecainide, and amiodarone decreases in this sequence. Fetal cardiac insufficiency accompanied by an elevation of the UVP might reduce the transplacental transfer of these drugs, although no significant difference could be found between the reduction of transfer of digoxin and flecainide.

Topics: Amiodarone; Anti-Arrhythmia Agents; Area Under Curve; Digoxin; Female; Fetal Diseases; Flecainide; Humans; In Vitro Techniques; Placenta; Pregnancy; Regional Blood Flow; Tachycardia, Supraventricular; Umbilical Veins; Venous Pressure

We report the case of a fetus with supraventricular tachycardia complicated by congestive heart failure and ascites. After failure of initial transplacental treatment, the injection of amiodarone into the umbilical vein combined with evacuation of ascites achieved conversion to sinus rhythm and restored cardiac function thus allowing pregnancy to go to term. This report suggests that direct fetal therapy by umbilical vein puncture and evacuation of effusions constitutes an effective treatment for supraventricular tachycardias with massive fetal hydrops which do not respond to transplacental treatment.

Topics: Adult; Amiodarone; Anti-Arrhythmia Agents; Digoxin; Female; Fetal Diseases; Heart Rate, Fetal; Humans; Hydrops Fetalis; Injections, Intravenous; Pregnancy; Tachycardia, Supraventricular; Umbilical Veins

Topics: Cardiotonic Agents; Digitoxin; Digoxin; Drug Administration Schedule; Drug Overdose; Heart Failure; Humans; Risk Factors; Tachycardia, Supraventricular

To manage fetal tachyarrhythmia induced hydrops, both a correct diagnosis and adequate intrauterine therapy are fundamentally important. We present a 32-week-gestational-age hydropic fetus with supraventricular tachycardia who responded dramatically after transplacental administration of high dose digoxin (1 mg intravenously daily). The baby was born at 36 weeks' gestation followed by a successful postnatal conversion. Prenatal fetal echocardiography is emphasized in determining appropriate treatment and monitoring fetal well-being which in this case resulted in a good outcome.

Topics: Adult; Digoxin; Female; Fetal Diseases; Humans; Hydrops Fetalis; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Prenatal

To determine whether M mode echocardiography can differentiate fetal supraventricular tachycardia according to the ventriculo-atrial (VA) time interval, and if the resulting division into short and long VA intervals holds any relation with clinical presentation, management, and fetal outcome.. Retrospective case series.. 23 fetuses with supraventricular tachycardia.. A systematic review of the M mode echocardiograms (for VA and atrioventricular (AV) interval measurements), clinical profile, and final outcome.. 19 fetuses (82.6%) had supraventricular tachycardia of the short VA type (mean (SD) VA/AV ratio 0.34 (0.16); heart rate 231 (29) beats/min). Tachycardia was sustained in six and intermittent in 13. Hydrops was present in three (15.7%). Digoxin, the first drug given in 14, failed to control tachycardia in five. Three of these then received sotalol and converted to sinus rhythm. All fetuses of this group survived. Postnatally, supraventricular tachycardia recurred in three, two having Wolff-Parkinson-White syndrome. Four fetuses (17.4%) had long VA tachycardia (VA/AV ratio 3.89 (0.82); heart rate 226 (10) beats/min). Initial treatment with digoxin was ineffective in all, but sotalol was effective in two. Heart failure caused fetal death in one and premature delivery in one. All three surviving fetuses had recurrences of supraventricular tachycardia after birth: two had the permanent form of junctional reciprocating tachycardia and one had atrial ectopic tachycardia.. Careful measurement of ventriculo-atrial intervals on fetal M mode echocardiography can be used to distinguish short from long VA supraventricular tachycardia and may be helpful in optimising management. Digoxin, when indicated, may remain the drug of choice in the short VA type but appears ineffective in the long VA type.

Topics: Anti-Arrhythmia Agents; Digoxin; Echocardiography, Doppler; Electrocardiography; Female; Fetal Distress; Gestational Age; Humans; Infant, Newborn; Maternal-Fetal Exchange; Pregnancy; Retrospective Studies; Tachycardia, Supraventricular; Treatment Outcome; Ultrasonography, Prenatal

The effectiveness and safety of antiarrhythmic agents, mostly digoxin and amiodarone given to prevent recurrences, were compared in 141 infants of less than 1 year (77% < 1 month) with re-entrant supraventricular tachycardia.. Digoxin was the drug of first choice in 114 patients at a dose of 10-20 micrograms/kg/d and was effective in 74 cases (65%). Amiodarone was used as first line therapy or after failure of digoxin. It was given at a maintenance dose of 250 mg/m2/d, alone in 22 infants and together with digoxin in another 36; it was effective in 56 cases (96.5%). Early adverse events occurred in six patients receiving digoxin: ventricular fibrillation requiring cardioversion in three, two of whom had Wolff-Parkinson-White syndrome, significant sinus bradycardia in two, accidental overload in one. At further follow-up, one child treated with digoxin but having also gastroesophageal reflux, died suddenly at 3 months of age; autopsy was normal and the digoxin blood level was 3 ng/mL. Among the 58 infants who received amiodarone, there were no proarrhythmia, a slight and transient increase in TSH in six infants and only one required a short-term treatment for hypothyroidism. Prophylactic therapy was maintained for 6 to 12 months and only ten patients had recurrences in the year following withdrawal.. Amiodarone was found to be safer and more effective than digoxin. No significant side-effect was demonstrated in infants receiving a short-term treatment. Amiodarone may be proposed as first line therapy for prophylaxis of re-entrant supraventricular tachycardia in infancy, especially for those patients with reentry and Wolff-Parkinson-White syndrome.

Topics: Amiodarone; Anti-Arrhythmia Agents; Digoxin; Electric Countershock; Electrocardiography; Humans; Infant; Practice Guidelines as Topic; Recurrence; Retrospective Studies; Tachycardia, Supraventricular; Ventricular Fibrillation

A gravid patient with fetal supraventricular tachycardia is presented. A review of this rare condition and the present recommended mode of therapy are discussed.

Topics: Administration, Oral; Adult; Anti-Arrhythmia Agents; Digoxin; Electrocardiography; Female; Heart Rate; Heart Rate, Fetal; Humans; Infant, Newborn; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Prenatal

Topics: Anti-Arrhythmia Agents; Digoxin; Electrocardiography; Esophagus; Follow-Up Studies; Humans; Infant, Newborn; Predictive Value of Tests; Propranolol; Prospective Studies; Recurrence; Risk; Tachycardia, Supraventricular; Wolff-Parkinson-White Syndrome

The diagnosis of supraventricular tachycardia has become much more important with the advent of radiofrequency ablation. This is usually best done at presentation in an acute setting. A 12-lead electrocardiogram should be a routine aid in making the diagnosis. A continuous rhythm strip must be obtained during administration of adenosine and at the termination of tachycardia. Most recent treatment guidelines would include adenosine as first-line therapy. If adenosine fails to restore normal sinus rhythm, diltiazem or a beta blocker should then be considered. If there is significant heart failure, digoxin may be useful. In the presence of wide complexes, agents that produce atrioventricular nodal block should be avoided.

Topics: Acute Disease; Adenosine; Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Calcium Channel Blockers; Catheter Ablation; Digoxin; Diltiazem; Electrocardiography; Humans; Tachycardia, Supraventricular

Topics: Anti-Arrhythmia Agents; Digoxin; Drug Therapy, Combination; Electrocardiography; Female; Fetal Death; Fetal Diseases; Flecainide; Gestational Age; Heart Failure; Humans; Hydrops Fetalis; Infant, Newborn; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Prenatal

To assess the efficacy and safety of current pharmacologic therapy for supraventricular tachycardia (SVT) in infants, we reviewed 112 infants treated between July 1985 and March 1993. The SVT mechanism was determined by esophageal electrophysiologic study and involved an accessory pathway in 86, atrioventricular (AV) node reentry in 10, atrial muscle reentry in 11, and an ectopic atrial tachycardia in 5 patients. Of six infants not treated, none had clinical recurrences of SVT. Of the 106 patients treated, 70% remained free of tachycardia while receiving digoxin, propranolol, or both. Class I antiarrhythmic agents were necessary for 13 patients, and class III agents were required for another 13 infants. Verapamil was used in one infant with AV node reentry tachycardia. Nine infants with complex clinical presentations were believed to have failed medical management and underwent radiofrequency ablation. Five patients died, four of complications related to structural heart disease and one shortly after radiofrequency ablation was performed. No deaths appeared to be related to antiarrhythmic medications. No drug-related side effects requiring medication change occurred, and no proarrhythmia was observed. Thus medical therapy appears to be effective and safe in infants with SVT. Radiofrequency ablation should be reserved for rare infants who fail aggressive medical regimens or when the situation is complicated by ventricular dysfunction, severe symptoms, or complex congenital heart disease.

Topics: Anti-Arrhythmia Agents; Catheter Ablation; Digoxin; Electrocardiography; Esophagus; Female; Follow-Up Studies; Heart Block; Heart Conduction System; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Propranolol; Recurrence; Retrospective Studies; Risk Factors; Survival Rate; Tachycardia, Atrioventricular Nodal Reentry; Tachycardia, Ectopic Atrial; Tachycardia, Supraventricular; Verapamil

We reviewed the ultrasonographic studies and the clinical course of 22 fetuses with supraventricular tachycardia to determine whether the heart rate alone could serve as a basis for conservative management. Hydrops was not encountered with heart rates under 230 beats per minute. The conditions of all 22 fetuses stabilized without invasive administration of medications. Eighteen were delivered vaginally and only four by cesarean section. No fetal or neonatal losses occurred. Regardless of the type of supraventricular tachycardia, reducing heart rate in these fetuses to levels preventing or resolving hydrops allowed term vaginal delivery, thereby reducing the substantial problems of ventilating an immature or hydropic neonate.

Topics: Anti-Arrhythmia Agents; Digoxin; Echocardiography, Doppler, Color; Female; Fetal Diseases; Gestational Age; Heart Rate, Fetal; Humans; Hydrops Fetalis; Pregnancy; Pregnancy Outcome; Quinidine; Retrospective Studies; Tachycardia, Supraventricular; Treatment Outcome; Ultrasonography, Prenatal

A 50-year-old man with 'presyncope' is presented. He was found to have an aneurysm of the right coronary sinus of Valsalva and an aneurysm of the noncoronary sinus. Neither aneurysm had ruptured. It is postulated that the patient's symptoms were related to partial obstruction of the right ventricle. Other potential complications of an unruptured aneurysm of the sinus of Valsalva are discussed.

Topics: Aneurysm; Digoxin; Echocardiography; Humans; Male; Middle Aged; Pacemaker, Artificial; Risk Factors; Sinus of Valsalva; Syncope; Tachycardia, Supraventricular

The supraventricular tachycardia is a life threatening state in the intrauterine life. It can cause non-immune hydrops fetalis, intrauterine death or complications during the delivery. The unexplained tachycardia can cause fetal distress and premature delivery. Usually the digoxin is the first drug of choice for transplacental cardioversion. If digitalisation does not achieve cardioversion, the second line antiarrhythmic drugs should be instituted. Amiodarone has been suggested as a therapeutic alternative after failure of digoxin-verapamil combination. We give a drug in standard therapeutic doses for four-five days and after it we determine whether it is effective or not. We should determine the newer therapy or termination of pregnancy. The transplacental administration of amiodarone may be dangerous because of fetal cretinism. Our case is the first in Hungary-in our best knowledge- and we suggest the amiodarone for transplacental therapy.

Topics: Adult; Amiodarone; Anti-Arrhythmia Agents; Digoxin; Drug Therapy, Combination; Female; Fetal Death; Fetal Diseases; Humans; Hungary; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Prenatal

Maternally administered digoxin for the treatment of fetal supraventricular tachycardia (SVT) complicated by hydrops fetalis may be ineffective secondary to poor transplacental drug transfer. We present our experience with eight pregnancies treated with transplacental therapy or combined maternal and direct fetal intramuscular therapy. Response to treatment following maternal intravenous administration (MIV) of digoxin or a combination of fetal intramuscular (FIM) digoxin and MIV is described for eight hydropic fetuses during nine successful pharmacologic conversions. The MIV digoxin was administered using standard loading and maintenance protocols. FIM was administered at a dose of 88 micrograms/kg q 12-24 hours, to a maximum of three injections in the fetal buttock. Time to onset of the first two hours of sinus rhythm (TO2 degrees), time to onset > 90% sinus rhythm (TO > 90%), and time to resolution of hydrops fetalis (HF) were noted. The mean heart rate was 257 +/- 36 beats/minute and the mean gestational age was 29 +/- 4.8 weeks. Fetal SVT was due to a reentrant mechanism in all cases. For the three fetuses that underwent successful cardioversion following MIV digoxin (all required additional maternal antiarrhythmic drugs), TO2 degrees was 145 +/- 114 hours, TO > 90% was 176 +/- 55 hours, and HF resolved in 41 +/- 37 days. Initial combined FIM and MIV therapy in four fetuses resulted in a TO2 degrees of 5.5 +/- 4 hours, TO > 90% of 22 +/- 14 hours, and resolution of HF in 25 +/- 21 days. For the two failed cardioversions with transplacental treatment alone (one fetus had recurrent SVT with hydrops after initial successful cardioversion with MIV), TO2 degrees was 203 +/- 180 hours and TO > 90% was 313 +/- 270 hours. Once FIM was begun in these fetuses, TO2 degrees was 17 +/- 7 hours and TO > 90% was 60 +/- 13 hours; HF resolved in 45 days in one fetus, whereas the other fetus never had resolution of hydrops despite 100 days of antiarrhythmic therapy. Direct fetal intramuscular injection of digoxin combined with transplacental therapy appears to shorten the time to initial conversion of SVT and to sustain sinus rhythm in the fetus with SVT complicated by hydrops fetalis.

Topics: Anti-Arrhythmia Agents; Digoxin; Echocardiography; Female; Fetal Diseases; Fetal Heart; Humans; Hydrops Fetalis; Injections, Intramuscular; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Prenatal

Topics: Blood Flow Velocity; Digoxin; Echocardiography, Doppler, Pulsed; Female; Heart Rate, Fetal; Hemodynamics; Humans; Injections, Intravenous; Maternal-Fetal Exchange; Parity; Pregnancy; Pregnancy Trimester, Third; Tachycardia, Supraventricular; Ultrasonography, Prenatal

Adenosine terminates supraventricular reentry tachycardia safely and effectively in the pediatric age group.. The recurrence of pretreated incessant tachycardia led to severe hydrops in a 28-week-old fetus. The tachycardia was terminated instantly with direct fetal administration of adenosine via the umbilical vein. Normal heart rate and rhythm were then preserved temporarily with digoxin and flecainide.. Direct fetal adenosine administration might be helpful in the treatment of fetal reentry tachycardias if the sinus rhythm achieved quickly can be preserved by long-acting antiarrhythmic drugs. Such a combined therapeutic approach might be especially advantageous in hydropic fetuses.

Topics: Adenosine; Digoxin; Female; Fetal Death; Flecainide; Gestational Age; Heart Rate; Humans; Hydrops Fetalis; Injections, Intravenous; Pregnancy; Recurrence; Tachycardia, Supraventricular; Ultrasonography; Umbilical Veins

Topics: Adenosine; Anti-Arrhythmia Agents; Cardiovascular Agents; Contraindications; Digoxin; Drug Interactions; Humans; Infant, Newborn; Tachycardia, Supraventricular; Ventricular Fibrillation; Wolff-Parkinson-White Syndrome

Topics: Adult; Digoxin; Female; Fetal Diseases; Humans; Pregnancy; Procainamide; Tachycardia, Supraventricular; Ultrasonography, Prenatal

Topics: Adult; Anti-Arrhythmia Agents; Digoxin; Female; Fetal Diseases; Gestational Age; Humans; Male; Maternal-Fetal Exchange; Pregnancy; Tachycardia, Supraventricular

Topics: Anti-Arrhythmia Agents; Digoxin; Drug Therapy, Combination; Electrocardiography; Humans; Infant, Newborn; Male; Propranolol; Tachycardia, Supraventricular

After a short introduction about the current role of digitalis in the treatment of the supraventrical arrhythmias and about the factors that make often problematic the achievement of an optimal posology of the drug, the results relative to more recent 340 digoxinaemia determinations in patients of Policlinico in Palermo or in outpatients are presented. Just the 43.8% of the patients had a digoxinaemia value in the range considered therapeutic; just 45 patients (32.1%), out of the 140 in which the digoxinaemia had been monitored for, at least, 5 days, were in the therapeutic range at the first determination; the 47.8% of the patients were underdosed and the 38.8% of them showed higher values than the therapeutic range. Determination 5 or more days later showed digoxinaemia values in the therapeutic range in 112 patients (80%). According to the reported results, it may be presumed that the posology correction effectuated by the physician on these patients might have been driven by the digoxinaemia values, whose determination must be considered an unavoidable guide to the digitalis treatment.

Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Digitalis Glycosides; Digoxin; Dose-Response Relationship, Drug; Humans; Italy; Practice Patterns, Physicians'; Tachycardia, Supraventricular

Fetal supraventricular tachycardia (SVT) can be successfully treated transplacentally, but in cases where fetal hydrops develops there is considerable morbidity and mortality. The present study was carried out to establish whether the introduction of flecainide altered obstetric management and fetal outcome. A retrospective analysis took place of 51 singleton pregnancies which were referred to the division of prenatal diagnosis because of fetal tachycardia between 1982 and 1993. SVT was documented in 50 out of 51 fetuses, one of which displayed a combination of extensive rhabdomyomas and severe hydrops and died shortly after referral. In the other fetus ventricular tachycardia was diagnosed. Of the remaining 49 fetuses, 14 did not receive any prenatal treatment, but nine needed postnatal treatment. Transplacental treatment of SVT took place in 35 fetuses, of which 22 presented without hydrops and 13 with hydrops. These subsets differed significantly with respect to restoration of normal sinus rhythm (73% vs. 30%; p < 0.001) and mortality (0% vs. 46%; p < 0.001). Digoxin was effective in restoring sinus rhythm in 55 per cent of the non-hydropic fetuses but in only eight per cent of the hydropic fetuses. Flecainide was effective in restoring sinus rhythm in all non-hydropic fetuses where digoxin treatment failed, and in 43 per cent of hydropic fetuses. Administration of flecainide resulted in a significantly reduced mortality (p < 0.001) compared with digoxin treatment. No adverse effects were seen. Postnatal anti-arrhythmic treatment was necessary in 23 infants. Treatment could be withdrawn within one year in all cases but one.

Topics: Anti-Arrhythmia Agents; Digoxin; Edema; Female; Fetal Diseases; Flecainide; Humans; Pregnancy; Retrospective Studies; Survival Rate; Tachycardia, Supraventricular; Treatment Outcome

A previously healthy and normally developing 12-day-old female suddenly became restless and developed cold sweats, tachypnoea and tachycardia (300 beats/min). Neither electrocardiogram nor echocardiogram showed evidence of any cardiac defect. Carotid sinus massage and other vagus-stimulating manoeuvres, undertaken because paroxysmal supraventricular tachycardia (PSVT) was suspected, were unsuccessful. Before rapid digitalization, adenosine triphosphate was administered (0.1 mg/kg intravenously). Sinus rhythm was restored within about 60 s. Despite further treatment with digoxin and verapamil (4 mg/kg.d), further episodes of PSVT occurred, each again responding to ATP (0.1 to 0.3 mg/kg). There were no side effects. After 24-hour Holter ECG monitoring had revealed Wolff-Parkinson-White syndrome as cause of the PSVT, propafenone was administered (15 mg/kg daily) and has prevented further recurrence of the tachycardia.

Topics: Adenosine Triphosphate; Digoxin; Drug Therapy, Combination; Echocardiography; Electrocardiography; Electrocardiography, Ambulatory; Female; Humans; Infant, Newborn; Propafenone; Tachycardia, Supraventricular; Verapamil; Wolff-Parkinson-White Syndrome

The aim of this study was to evaluate fetal tachycardia and the efficacy of maternally administered antiarrhythmic agents and the effect of this therapy on delivery and postpartum management.. Sustained fetal tachycardia is a potentially life-threatening condition in which pharmacologic therapy is reported to be effective. There is ongoing discussion about optimal management.. A group of 51 patients with M-mode echocardiographically documented fetal tachycardia was studied retrospectively.. Thirty-three fetuses had supraventricular tachycardia; 15 had atrial flutter; 1 had two episodes of both; and 2 had ventricular tachycardia. Fetal hydrops was seen in 22 patients. Thirty-four fetuses received maternal therapy with either digoxin or flecainide as the first administered drug (additional drugs were given in 12). Drug treatment was successful in establishing acceptable rhythm control in 82% (84% without, 80% with hydrops). In the latter group the median number of drugs and number of days to conversion were higher. Three patients with fetal hydrops died. In 50% of cases, tachycardia reappeared at delivery: 9 neonates presented with atrial flutter, 14 with supraventricular tachycardia and 1 with ventricular tachycardia. Seventy-eight percent of the group had pharmacologic therapy by 1 month of age and 14% by 3 years.. Fetal tachycardia can be treated adequately in the majority of patients, even in the presence of hydrops, and therefore emergency delivery might not be indicated. Digoxin and flecainide were drugs of first choice and produced no serious adverse effects in this series of patients. The majority of patients do not require prolonged therapy.

Topics: Atrial Flutter; Digoxin; Echocardiography; Female; Fetal Diseases; Fetal Heart; Flecainide; Follow-Up Studies; Humans; Hydrops Fetalis; Infant, Newborn; Pregnancy; Retrospective Studies; Tachycardia, Supraventricular; Treatment Outcome; Ultrasonography, Prenatal

Topics: Adult; Aged; Child; Digitoxin; Digoxin; Drug Interactions; Heart Failure; Humans; Tachycardia, Supraventricular

Topics: Adenosine; Adult; Digoxin; Female; Fetal Diseases; Flecainide; Heart Rate, Fetal; Humans; Infant, Newborn; Male; Pregnancy; Tachycardia, Supraventricular; Wolff-Parkinson-White Syndrome

We present a case of persistent fetal supraventricular tachycardia where transplacental and direct fetal treatment with amiodarone caused an iatrogenic hypothyroidism. This condition was successfully managed with the intra-amniotic instillation of 250 micrograms of L-thyroxine weekly, for 3 weeks. A male infant was delivered at 32 weeks by Caesarean section. The neonatal electrocardiogram showed Wolf-Parkinson-White (WPW) syndrome, which was controlled by digoxin alone. Thyroid function normalized quickly and the baby is developing normally.

Topics: Adult; Amiodarone; Digoxin; Female; Fetal Diseases; Humans; Hypothyroidism; Infant, Newborn; Male; Pregnancy; Tachycardia, Supraventricular; Thyroxine; Wolff-Parkinson-White Syndrome

Topics: Administration, Oral; Adult; Digoxin; Female; Fetal Diseases; Humans; Infant, Newborn; Male; Placenta; Pregnancy; Pregnancy Trimester, Third; Tachycardia, Supraventricular

We report two cases of fetal supraventricular tachycardia with hydrops fetalis. The transplacental therapy with digoxin, sotalol and amiodarone, using combination of both of this drugs, has given in one case a partial conversion, total in the second case. Ultrasounds allow diagnosis of SVT, evaluate the gravity when it is associated with fetal hydrops secondary to a congestive heart failure, research a cause and follow the evolution during the treatment. The treatment must begin when diagnosis of SVT is done, by digoxin; other drugs as sotalol, amiodarone or flecainide acetate are described and also direct fetal therapy by intramuscular or into the umbilical vein injections.

Topics: Adrenergic beta-Antagonists; Adult; Amiodarone; Digoxin; Drug Therapy, Combination; Female; Fetal Diseases; Humans; Hydrops Fetalis; Pregnancy; Tachycardia, Supraventricular; Ultrasonography, Prenatal

Topics: Digoxin; Humans; Postoperative Complications; Premedication; Tachycardia, Supraventricular; Thoracotomy

In view of their potentially dangerous proarrhythmic effects, antiarrhythmic drugs should only be prescribed for patients with poorly tolerated symptomatic supraventricular arrhythmias. The choice of a suitable preparation depends not only on the type of arrhythmia, but also on the underlying heart disease and left-ventricular function. Digoxin, verapamil, sotalol and quinidine remain first-line drugs, while in view of recent trials the type-1c antiarrhythmics (flecainide) should only be given in cases resistant to other agents. Amiodarone is also an important and efficacious "reserve" antiarrhythmic, which has to be utilized at low doses to avoid its well-known side effects.

Topics: Amiodarone; Anti-Arrhythmia Agents; Digoxin; Flecainide; Humans; Quinidine; Tachycardia, Supraventricular

Topics: Adult; Digoxin; Female; Fetal Diseases; Flecainide; Humans; Pregnancy; Tachycardia, Supraventricular

The earliest reported case of fetal supraventricular tachycardia at 17 weeks' gestation causing hydrops fetalis is presented. Maternal treatment with digoxin and procainamide successfully cardioverted the fetus with resolution of the hydrops. Using this combination, sinus rhythm was maintained until term.

Topics: Digoxin; Drug Therapy, Combination; Fetal Diseases; Gestational Age; Humans; Hydrops Fetalis; Infant, Newborn; Male; Procainamide; Propranolol; Tachycardia, Supraventricular

Sotalol, a nonselective beta blocking agent with additional Class III activity has been shown to be extremely effective in the treatment of supraventricular tachycardias in adults and children. Little information is available on its use in infants. From August, 1985 to April, 1990, 18 infants, 2 months of age or less, were treated with oral sotalol for supraventricular arrhythmias. Their age ranged from a few hours to 2 months, mean 5 weeks, at the start of treatment. Weights were between 2.58-5 kg, mean 3.9 kg and dosage 2-4 mg/kg/24 hrs given in two equal doses, 12 hourly. Sixteen infants had structurally normal hearts, one had multiple cardiac rhabdomyomas, and one was postoperative Mustard procedure for transposition of the great arteries. Thirteen of 18 infants had reentrant forms of supraventricular tachycardia, six of these had overt preexcitation. Two infants had chaotic atrial tachycardia, two atrial flutter, and one with ectopic atrial tachycardia. Previous antiarrhythmic therapy had been unsuccessful in 12 patients. All infants, except one with chaotic atrial tachycardia, were successfully controlled with sotalol. Ten infants discontinued therapy between the ages of 7 and 18 months as it was felt to be no longer necessary. Mean duration of treatment was 12.8 months. Three had recurrences of their arrhythmia and were again successfully controlled by sotalol. Mild sinus bradycardia occurred in all infants. No other side effects were noted. Sotalol is an effective, safe drug for the treatment of supraventricular tachycardias in early infancy.

Topics: Digoxin; Drug Therapy, Combination; Electrocardiography; Female; Humans; Infant, Newborn; Male; Sotalol; Tachycardia, Supraventricular

Poorly controlled supraventricular arrhythmias in a hypokalaemic 74 year old woman were treated with oral amiodarone. This caused torsades de pointes, and was preceded by marked prolongation of the QT interval. The induction of torsades de pointes by amiodarone is thought to be an idiosyncratic reaction to amiodarone itself which is facilitated by electrolytic abnormalities. The present case, however, indicates the possibility of a pro-arrhythmic effect secondary to an interaction between amiodarone and digoxin.

Topics: Administration, Oral; Aged; Amiodarone; Digoxin; Drug Interactions; Electrocardiography; Female; Humans; Hypokalemia; Tachycardia, Supraventricular; Torsades de Pointes

A 25-week fetus with severe hydrops fetalis secondary to supraventricular tachycardia was treated with fetal intramuscular injections of digoxin in conjunction with maternal intravenous digoxin, followed by oral digoxin and subsequently by oral procainamide therapy. Fetal umbilical blood sampling revealed poor placental transfer of digoxin, even after 2 weeks of therapeutic maternal levels. This case suggests that direct fetal therapy is of value in the treatment of some fetuses with supraventricular tachycardia, and lends further evidence that the role of transplacental digoxin therapy is limited in the compromised fetus. It also demonstrates that resolution of hydrops may require a prolonged period.

Topics: Adult; Digoxin; Female; Fetal Diseases; Fetus; Humans; Hydrops Fetalis; Injections, Intramuscular; Injections, Intravenous; Maternal-Fetal Exchange; Pregnancy; Procainamide; Tachycardia, Supraventricular

Nine patients with supraventricular rhythm disorders were treated during 5-day periods with different oral doses (300, 450, 600, and 900 mg daily) of propafenone concomitantly to long-term digoxin treatment. A poor correlation (r = .398; P less than .05) was obtained when the difference between the mean digoxin serum level (calculated with the Cmin data determined each of the 5 days) observed during a given propafenone dose and the mean digoxin serum level observed before propafenone treatment, was correlated with the dose of propafenone; but an evident correlation (r = .778; P less than .01) was found when the difference in digoxin level was correlated with the plasma propafenone concentration. The propafenone effect of increasing digoxin blood levels was thus concluded to be poorly dose dependent but strongly concentration dependent. The association of propafenone to a long-term digoxin treatment can be considered with a low risk of toxicity when plasma propafenone concentration does not exceed about 1000 ng/mL. Propafenone plasma levels are unpredictable in view of their wide interindividual variation for a given dose, so their measurement is advised to detect high levels and consequently to prevent a rise in digoxin serum concentrations with the possibility of toxicity. In clinical practice, when propafenone concentration determinations are not readily available, digoxin serum levels at least have to be carefully monitored.

Topics: Administration, Oral; Aged; Aged, 80 and over; Digoxin; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Propafenone; Tachycardia, Supraventricular

Topics: Adult; Digoxin; Electrocardiography; Humans; Male; Pneumothorax; Stress, Psychological; Tachycardia, Supraventricular

A complication of transesophageal atrial pacing in an infant with Wolff-Parkinson-White syndrome (WPW) is reported. A newborn infant born with fetal hydrops had recurrent supraventricular tachycardia (SVT) that required repeated successful conversion by transesophageal atrial pacing. Because of secondary left ventricular dysfunction, digoxin was administered. During repeat transesophageal atrial pacing for recurrent SVT, ventricular fibrillation occurred. Although it is unclear which of several possible contributing factors was responsible for the ventricular fibrillation, recommendations are appropriate to minimize the risk in infants with WPW.

Topics: Cardiac Pacing, Artificial; Digoxin; Esophagus; Female; Humans; Infant, Newborn; Recurrence; Tachycardia, Supraventricular; Ventricular Fibrillation; Wolff-Parkinson-White Syndrome

Intrauterine supraventricular tachycardia with consequent congestive heart failure is a high-risk fetal complication. It is one of the causes of non-immunological hydrops fetalis and may lead to premature delivery or even fetal loss. We report the successful intrauterine treatment of a case of hydrops fetalis due to supraventricular tachycardia by administration of digoxin and verapamil to the mother. Echocardiography is diagnostic and mandatory for follow up.

Topics: Digoxin; Drug Administration Schedule; Drug Therapy, Combination; Electrocardiography; Female; Fetal Blood; Heart Rate, Fetal; Humans; Hydrops Fetalis; Infant, Newborn; Infusions, Intravenous; Pregnancy; Prenatal Diagnosis; Tachycardia, Supraventricular; Verapamil

All patients with supraventricular tachycardia during the first 12 months of life who presented between 1977 and 1988 were identified by a retrospective survey of records in this hospital and by a questionnaire sent to paediatricians in the Northern region. Twenty two of 29 patients (76%) were in heart failure and seven (24%) had cardiogenic shock. Seven patients (24%) were free of symptoms. All had narrow QRS tachycardia at 215-315 beats/minute (mean (SD) 292 (21)). Initial treatment included digoxin (effective in seven of 14 patients, with overdose in three), verapamil (effective in three of three but fatal in one), cardioversion (effective in all 10 who were treated in this way), iced water applied to the face (effective in all 16 patients on 53 of 59 occasions, 90%). Initial treatment in local hospitals was less effective and associated with more complications than that given in the regional referral centre. Digoxin is often ineffective, return to sinus rhythm is delayed, and overdosing is common. Cardioversion is effective but tachycardia often recurs. Iced water is safe and effective, and should become the treatment of choice for termination of supraventricular tachycardia in neonates and young infants.

Topics: Adenosine; Digoxin; Electric Countershock; Humans; Hypothermia, Induced; Infant; Infant, Newborn; Prognosis; Retrospective Studies; Tachycardia, Supraventricular; Verapamil

We report the use of digoxin immune Fab in a seven-day-old male neonate for treatment of digoxin poisoning. The patient was being treated with digoxin for paroxysmal supraventricular tachycardia (PSVT). The prescription was written for digoxin elixir (50 micrograms/ml), 10 micrograms bid; however, it was dispensed as 100 micrograms bid. The patient had received seven of these doses over three and one half days prior to arrival at the emergency department. The patient received 40 mg of digoxin immune Fab fragments over one hour to bind a calculated maximum digoxin dose of 600 micrograms. The only complication was a transient episode of relative hypoglycemia 13 to 22 hours postinfusion with measured glucose readings between 43 and 52 mg/dl. The hypoglycemia responded to supplemental glucose and advancement of feedings. We believe that in massive and rapid electrolyte shifts in the neonate caused by digoxin immune Fab, glucose should be monitored closely.

Topics: Digoxin; Electrocardiography; Female; Humans; Immunoglobulin Fab Fragments; Infant, Newborn; Medication Errors; Tachycardia, Supraventricular

Treadmill exercise tests, electrophysiologic studies, and isoproterenol infusions were performed in 14 patients with exercise provocable supraventricular tachycardia to delineate the mechanisms of exercise provocation of paroxysmal supraventricular tachycardia. Treadmill exercise tests reproducibly provoked supraventricular tachycardia in all patients. Supraventricular tachycardia similar to that provoked by exercise occurred spontaneously during isoproterenol infusions in 9 of 11 patients tested. The specific supraventricular tachycardia diagnoses of all patients were atrial reentrant tachycardia (two patients), automatic atrial tachycardia (three), atrial flutter-fibrillation (one), atypical junctional tachycardia (two), and orthodromic atrioventricular (AV) reentrant tachycardia (six) as defined by electrophysiologic studies. Various mechanisms of exercise or isoproterenol induction of supraventricular tachycardia were identified. A critical heart rate and/or appropriate sympathetic state was found to provoke all instances of reentrant or automatic atrial tachycardia and atypical junctional tachycardia. A properly timed atrial premature beat provoked five of six cases of AV reentrant tachycardia and the only case of atrial flutter-fibrillation. The remaining case of AV reentrant tachycardia was induced by a ventricular premature beat. In conclusion, the mechanisms of exercise provocation of reentrant or automatic supraventricular tachycardia are multiple and include a critical sinus rate, increased sympathetic tone, and properly timed atrial or ventricular premature beats.

Topics: Adrenergic beta-Agonists; Adult; Aged; Aged, 80 and over; Digoxin; Drug Therapy, Combination; Electrocardiography; Electrophysiology; Exercise; Exercise Test; Female; Humans; Isoproterenol; Male; Middle Aged; Tachycardia, Supraventricular; Verapamil

Topics: Adult; Amiodarone; Digoxin; Female; Fetal Diseases; Humans; Hydrops Fetalis; Injections, Intravenous; Pregnancy; Pregnancy Outcome; Recurrence; Tachycardia, Supraventricular; Umbilical Veins; Verapamil

The hemodynamic response after an iv loading dose of amiodarone for resistant supraventricular tachyarrhythmias was studied in ten critically ill patients receiving a catecholamine infusion for shock. A loading dose of amiodarone, 3.7 to 5.0 mg/kg, was infused over 2 h while the catecholamine infusion dose requirements were monitored. There was a significant decrease in heart rate (mean 16%, p less than .01), and an increase in stroke volume index (mean 29%, p less than .01) and left ventricular stroke work index (mean 34%, p less than .01). Cardiac index, oxygen availability index, and mean arterial pressure were not changed significantly. The reported adrenoreceptor antagonism of amiodarone did not change catecholamine dose requirements in this study. In nine of ten patients, sinus rhythm was achieved and maintained. The loading dose of amiodarone had no significant acute effect on plasma digoxin concentrations. Despite good arrhythmia control, mortality was high.

Topics: Aged; Aged, 80 and over; Amiodarone; Cardiac Output; Catecholamines; Digoxin; Drug Synergism; Heart Rate; Hemodynamics; Humans; Middle Aged; Multiple Organ Failure; Stroke Volume; Tachycardia, Supraventricular

During the 29th week of gestation the authors diagnosed supraventricular tachycardia of the foetus and pathological echogenity in the region of the mitral valve, most probably of tumourous aetiology. By transplacental digitalization the supraventricular tachycardia was controlled; according to Doppler analysis the tumour did not interfere with the flow to the mitral orifice. Post-natally the diagnosis of a tumour in the left atrium was confirmed. Surgery was so far postponed in view of the normal haemodynamics.

Topics: Adult; Digoxin; Echocardiography; Female; Fetal Diseases; Heart Neoplasms; Humans; Infant, Newborn; Male; Pregnancy; Prenatal Diagnosis; Tachycardia, Supraventricular

Topics: Digoxin; Electrocardiography; Female; Humans; Infant; Infant, Newborn; Male; Tachycardia, Supraventricular

Topics: Digoxin; Drug Therapy, Combination; Female; Fetal Monitoring; Heart Rate, Fetal; Humans; Male; Pregnancy; Propranolol; Tachycardia, Supraventricular; Ultrasonography

Patients with supraventricular tachycardia should be able to lead a perfectly normal life without significant treatment related side effects. Many of these patients have normal hearts and no other significant medical problems. Using the techniques described above, no patient should have significant symptoms from SVT.

Topics: Anti-Arrhythmia Agents; Digoxin; Electric Countershock; Humans; Tachycardia, Supraventricular

Topics: Adenosine; Digoxin; Electrocardiography; Humans; Infant, Newborn; Male; Tachycardia, Supraventricular; Time Factors

Several studies have shown that the majority of patients receiving digoxin can be successfully withdrawn. A medical record review was conducted to determine whether, in practice, patients were being withdrawn from digoxin. Original indications for digoxin therapy in 163 outpatients were as follows: congestive heart failure (CHF), 50%; supraventricular tachycardia (SVT), 23%; CHF and SVT, 10%; and unknown/unclear, 17%. One third of these patients were withdrawn during the 3.5-year study, and 79% remained stable, off digoxin. The most significant predictor of withdrawal was chart indication of reassessment of the need for digoxin. The majority of the patients (68%) were reassessed, and of these, almost half were withdrawn. Physicians appear to be reassessing the need for digoxin therapy, resulting in higher withdrawal rates than previously reported. Results suggest that patients with unclear original indications, a onetime indication, or without clinical evidence of CHF or SVT can be successfully withdrawn.

Topics: Aged; Digoxin; Drug Utilization; Female; Heart Failure; Humans; Male; Medical Records; Middle Aged; North Carolina; Outpatient Clinics, Hospital; Practice Patterns, Physicians'; Substance Withdrawal Syndrome; Tachycardia, Supraventricular

This study was conducted to ascertain if critical peak body stores of digoxin were needed to protect patients from the debilities that result from supraventricular tachycardias occurring after open heart operations. We gave digoxin peak body stores of 15 micrograms/kg of lean body weight to 100 consecutive patients after open heart operations. If supraventricular tachycardias persisted four hours, we increased peak body stores to 17 or 19 micrograms/kg. The operations included coronary artery bypass grafts, heart valve replacements, and congenital defect correction. After operation, 18 patients had atrial fibrillation or flutter. During supraventricular tachycardias, ventricular rates were 150 beats per minute or slower. In the 100 patients, the median hospital stay after operation was four days. No patient required rehospitalization. The patients who had supraventricular tachycardias stayed in the hospital no longer than the patients who were at all times in regular sinus rhythm. All patients who entered the hospital with regular sinus rhythm went home with regular sinus rhythm. The critical safe peak body stores of digoxin needed to prevent debilities resulting from supraventricular tachycardias after open heart operations were 15 to 19 micrograms/kg of lean body weight.

Topics: Aged; Atrial Fibrillation; Atrial Flutter; Cardiac Surgical Procedures; Digoxin; Female; Humans; Male; Middle Aged; Postoperative Complications; Tachycardia, Supraventricular

Topics: Adrenergic beta-Antagonists; Anti-Arrhythmia Agents; Atrial Fibrillation; Digoxin; Humans; Tachycardia, Supraventricular

Vagal maneuvers terminate new onset, catheter-induced paroxysmal supraventricular tachycardia (PSVT) in up to 92% of patients. The risk and benefit of vagal maneuvers for treating PSVT in the emergency department (ED) is inadequately defined. The purpose of this study was to determine the efficacy of nonpharmacological vagal interventions in converting spontaneous episodes of PSVT in adult patients and to derive a treatment plan for such patients based on clinical decision analysis. Seventeen adult patients who presented to the ED because of PSVT were treated with carotid sinus massage, Valsalva maneuver, and head-down tilt (alone and in combination). Only three patients converted out of PSVT with vagal intervention. The remainder received verapamil, which converted 12 of the 14 patients (86%) who received the drug (one required digoxin, one required synchronized cardioversion). Vagal maneuvers are safe in young, otherwise healthy patients but problems have been documented in the literature in older patients, who have a higher likelihood of coronary and/or cerebrovascular disease. Clinical decision analysis indicates that young patients should be treated initially with vagal maneuvers but that older patients (above approximately 65 years of age) should be treated initially with verapamil.

Topics: Adult; Aged; Aged, 80 and over; Decision Support Techniques; Digoxin; Electric Countershock; Emergencies; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Prospective Studies; Tachycardia, Supraventricular; Valsalva Maneuver; Verapamil

Topics: Adult; Cardiomyopathy, Dilated; Chronic Disease; Digoxin; Drug Combinations; Electrocardiography; Humans; Male; Tachycardia, Supraventricular; Ultrasonography; Verapamil

The effects of intravenous encainide on digoxin-induced atrial ectopic tachycardia (AET) were investigated in the rat using 3-channel simultaneous limb-lead electrocardiography. Pentobarbital-anesthetized (35 mg/kg, intraperitoneal) adult male rats were given digoxin subcutaneously, 30 mg/kg. After onset of AET, rats received either saline (0.5 ml/kg) or encainide; 0.25, 0.5, 1.0, or 2.0 mg/kg intravenously in repeated doses at 15-min intervals. At all doses, encainide converted digoxin-induced AET to ventricular arrhythmias, prolonged recovery time, and increased mortality in comparison to saline-treated animals. An additional group of anesthetized rats was not given digoxin. These animals received encainide (2.0 mg/kg, intravenously) in repeated doses at 15-min interval and developed dose-related increase in the P-R interval only. Blood samples were obtained by cardiac puncture from 12 additional anesthetized, digoxin-treated rats 5 min after the fourth intravenous dose of saline (0.5 ml/kg, n = 6) or encainide (1.0 mg/kg, n = 6). Serum was prepared and analyzed by affinity column-mediated immunoassay. Digoxin levels were the same in both groups. These results suggest that encainide may exacerbate digoxin-induced arrhythmias (proarrhythmic effect) in this species. In view of our findings of digoxin-encainide interactions in the rat, we recommend caution if these drugs are coadministered in humans.

Topics: Anilides; Animals; Anti-Arrhythmia Agents; Digoxin; Disease Models, Animal; Drug Interactions; Electrocardiography; Encainide; Male; Rats; Rats, Inbred Strains; Tachycardia, Ectopic Atrial; Tachycardia, Supraventricular

Topics: Digoxin; Drug Interactions; Humans; Hypotension; Propranolol; Tachycardia, Supraventricular; Verapamil

Topics: Adult; Digoxin; Female; Fetal Diseases; Heart Auscultation; Humans; Pregnancy; Prenatal Diagnosis; Tachycardia, Supraventricular

A model of atrial ectopic tachycardia (AET) in the adult rat is described. Pentobarbital-anesthetized adult male rats given digoxin 30 mg/kg s.c. develop AET 50 min after administration. Heart rate and rhythm were determined by electrocardiography using limb leads, I, II and III. This model of AET is simple, sustained and economical. As a supplement to models of ventricular arrhythmias, this model might broaden the pre-clinical evaluation of antiarrhythmic agents.

Topics: Animals; Digoxin; Disease Models, Animal; Electrocardiography; Male; Rats; Rats, Inbred Strains; Tachycardia, Ectopic Atrial; Tachycardia, Supraventricular

Digitalization by direct intramuscular injection of the fetus successfully controlled supraventricular tachycardia at 24 weeks' gestation after more traditional intensive trials of transplacental therapy with digoxin, verapamil, and procainamide, either separately or in combination, had failed. The fetal pharmacokinetics were calculated from fetal blood samples obtained by cordocentesis. No clear evidence of placental transfer of digoxin administered to the mother could be found despite a digoxin concentration in the mother that ranged from 1.8 to 2.6 ng/ml for 4 days. After direct fetal digitalization we calculated that the coefficient of elimination for digoxin from the fetus was 0.0463 h-1, and digoxin elimination half-life was 15.9 hours. The latter time span is substantially less than the 50-hour half-life previously reported in newborn infants with low birth weight. The fetal/maternal concentration ratio of procainamide was 0.914. However, maternal clearance of procainamide (9.7 ml/kg-1/min-1) was twice as long as the clearance reported for nonpregnant patients undergoing fast acetylation. We conclude first, that at least in the dose of this ill fetus, little digoxin administered to the mother crossed the placentae; and second, that while direct fetal therapy with digoxin is effective, the necessary frequent number of injections render this therapy impractical. Direct fetal digitalization should probably be reserved for the preterm fetus who has evidence of heart failure and has not responded to maternally administered therapy other than digoxin.

Topics: Adult; Digoxin; Female; Fetal Diseases; Fetus; Humans; Maternal-Fetal Exchange; Pregnancy; Procainamide; Tachycardia, Supraventricular

A case of nonimmune hydrops fetalis associated with a supraventricular tachycardia was successfully treated with digoxin and verapamil. After resolution of the hydropic changes, however, the fetus unexplainedly died. Side effects from the drug therapy may have been responsible for the event.

Topics: Adult; Digoxin; Drug Therapy, Combination; Female; Fetal Death; Fetal Diseases; Humans; Pregnancy; Tachycardia, Supraventricular; Verapamil

Digoxin is the third most commonly prescribed drug, yet limited information exists about its use in outpatients. Therefore, 242 medical outpatients receiving digoxin at our hospital were studied to evaluate the appropriateness of its use, defined by: (1) current or past supraventricular arrhythmias and/or (2) left ventricular systolic dysfunction (ejection fraction less than 45 percent).. Charts of 242 patients receiving digoxin were obtained. The patients were divided into groups based upon their physician's stated indication for digoxin therapy. Patients with only a clinical diagnosis of congestive heart failure (CHF) underwent echocardiography or radionuclide angiography to quantify left ventricular systolic function. Those with documented supraventricular arrhythmias and/or those with confirmed left ventricular systolic dysfunction were classified as appropriate candidates for digoxin.. Ninety-five percent of patients received digoxin for appropriate indications; 75 percent had confirmed supraventricular arrhythmias (27 percent also had CHF) and 20 percent with normal sinus rhythm had documented systolic dysfunction. However, physicians had difficulty in the clinical assessment of left ventricular function; 18 percent of patients with sinus rhythm and CHF by the Framingham scoring system and 20 percent of those with supraventricular arrhythmias and CHF had preserved systolic function. An S3 was present in 15 percent of patients with preserved ejection fraction and CHF and in 69 percent with low ejection fraction; hypertension was significantly more common in the former group. Noninvasive assessment of systolic function was obtained in 97 percent of patients independent of this study, yet some patients without supraventricular arrhythmias and with documented preservation of systolic function continued to receive the drug.. Noninvasive assessment of left ventricular function, which appears to have become routine, is of value in the appropriate utilization of digoxin, since clinicians' assessment of left ventricular function may be inaccurate. Physicians also do not always discontinue digoxin therapy when indicated.

Topics: Aged; Ambulatory Care; Arrhythmias, Cardiac; Digoxin; Female; Heart Failure; Heart Ventricles; Humans; Male; Middle Aged; Stroke Volume; Systole; Tachycardia, Supraventricular

We have designed a simple nomogram for predicting digoxin dosage and have tested it prospectively in two consecutive studies. These were both conducted in hospital inpatients who were not already taking digoxin but who required drug therapy for atrial tachyarrhythmias and/or cardiac failure. Study I. Sixty-seven patients received digoxin according to the nomogram and 50 completed the ten day course of the study. Forty-one of these patients were eligible for the final analysis. On the tenth day of treatment, 28 patients were within the therapeutic range for plasma digoxin (0.8 to 2.0 ng.ml-1), 12 were subtherapeutic (less than 0.8 ng.ml) and one was potentially toxic (greater than 2.0 ng.ml-1). Study II. Thirty patients completed the second study. Digoxin was prescribed according to the nomogram with the addition of a dosage correction based on the plasma digoxin level on Day 3. On the tenth day of treatment, 24 patients were within the therapeutic range, one in the subtherapeutic and 5 in the potentially toxic. This simple digoxin nomogram, with or without the Day 3 dosage correction, should prove to be a useful aid to prescribing in patients who do not require rapid digitalisation. It is particularly relevant to elderly inpatients with atrial tachyarrhythmias and/or cardiac failure.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Digoxin; Female; Heart Failure; Humans; Male; Middle Aged; Prospective Studies; Tachycardia, Supraventricular; Urea

The authors present a case history of supra-ventricular tachycardia (SVT) diagnosed in a fetus after 32 weeks of amenorrhoea in a 2-para woman of 29 years. This SVT was discovered after an urgent consultation had been asked for when uterine contractions started after the uterus had been over-distended. The diagnosis that had been suspected when it had been impossible to measure the fetal heart rate by a monitor was confirmed when the rate was found to be 270 beats per minute using TM ultrasound. A complete detailed ultrasound examination showed that there was generalised oedema (anasarca). Searching for a congenital malformation revealed none. Other tests eliminated other causes for the anasarca. Treatment was rapidly instituted by injecting 2 and later 3 ampoules of 0.25 mg of Digoxin in 24 hours. This did not change the fetal heart rate although continued for five days. Adding Amiodarone into a transfusion at the rate of 3 ampoules in 24 hours slowed the fetal heart rate to 220 beats per minute within 24 hours. After 3 days treatment with Amiodarone the heart rate went into sinusal rhythm. A boy weighing 3,410 g was delivered by caesarean section 3 days later after the membranes had ruptured prematurely. The placenta weighed 1,750 g. The newborn infant was transferred into a special care baby unit where it progressed favourably. The child left the unit after six weeks on treatment with Digoxin. Consulting the literature has shown under what circumstances the condition can arise and the ways of diagnosing it and the differential diagnosis of fetal SVT, as well as methods of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Amiodarone; Digoxin; Drug Therapy, Combination; Female; Fetal Diseases; Humans; Pregnancy; Tachycardia, Supraventricular

A three-year-old child with arrhythmia-induced cardiomyopathy is presented. Drug treatment produced immediate symptomatic relief and subsequent reversion to normal cardiac size and function. This demonstrates that reduction of ventricular rate by drug treatment produces resolution of arrhythmia-induced cardiomyopathy and that surgical excision of atrial automatic focus is not always necessary.

Topics: Cardiomyopathy, Dilated; Child, Preschool; Digoxin; Drug Therapy, Combination; Electrocardiography; Humans; Male; Tachycardia, Supraventricular; Verapamil

A case of severe nonimmune hydrops fetalis caused by supraventricular tachycardia is presented. Maternal treatment with digoxin and the subsequent addition of verapamil and propranolol failed to be effective. Simultaneous measurement of maternal serum and cord blood digoxin levels showed insufficient transplacental digoxin transfer. Other modalities of treatment are discussed.

Topics: Adult; Digoxin; Edema; Female; Fetal Diseases; Humans; Maternal-Fetal Exchange; Pregnancy; Propranolol; Tachycardia, Supraventricular; Verapamil

The efficacy of verapamil in the conversion of 47 episodes of supraventricular tachycardia in 22 children was evaluated. The age of the patients ranged from 15 days to 10 years. Tachycardia was the main mode of presentation. Ten out of 22 children had viral infections. Two patients developed mild cardiac failure. Six patients had underlying cardiac abnormalities. Forty-four out of 47 episodes of supraventricular tachycardia were converted to sinus rhythm by a single dose of verapamil (0.11 +/- 0.08 mg/kg). No significant side-effects were observed. Intravenous verapamil is an effective and safe drug for the conversion of supraventricular tachycardia in children.

Topics: Child; Child, Preschool; Digoxin; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Male; Neostigmine; Propranolol; Tachycardia, Supraventricular; Verapamil

Although digoxin is often the first choice for control of ventricular response in chronic atrial fibrillation, it fails to slow exercise rates. Diltiazem, a calcium channel antagonist that slows atrioventricular conduction, was administered to 16 patients who failed to achieve adequate rate control on low level exercise testing despite digoxin therapy. Therapeutic response to diltiazem was assessed with submaximal and maximal exercise tests and 24 hour ambulatory electrocardiographic monitoring. During the diltiazem treatment phase, ventricular response at rest diminished (96 +/- 17 versus 69 +/- 10 beats/min, p less than 0.001) as did rate during submaximal exercise (155 +/- 28 versus 116 +/- 26, p less than 0.001), maximal exercise (163 +/- 14 versus 133 +/- 26, p less than 0.001) and average ventricular response during 24 hour monitoring (87 +/- 13 versus 69 +/- 10, p less than 0.001). Rate at rest decreased 26 +/- 15% and submaximal exercise rate diminished 24 +/- 12%. Thirteen (81%) of the 16 patients exhibited at least 15% slowing of rate at rest and during submaximal exercise. Eleven patients (69%) reported alleviation of symptoms. There was no change in serum digoxin levels during diltiazem treatment (1.3 +/- 0.5 versus 1.3 +/- 0.6 ng/ml, p = NS). On withdrawal of diltiazem, ventricular response returned to baseline values. Diltiazem is an effective agent for control of ventricular response, both at rest and during exercise, in digoxin-treated patients with chronic atrial fibrillation.

Topics: Adult; Aged; Atrial Fibrillation; Digoxin; Diltiazem; Drug Evaluation; Female; Heart Rate; Hemodynamics; Humans; Male; Middle Aged; Physical Exertion; Rest; Tachycardia, Supraventricular

Topics: Aged; Digoxin; Drug Interactions; Female; Humans; Tachycardia, Supraventricular; Verapamil

Six newborn infants with intrauterine supraventricular tachyarrhythmias (five cases of atrial flutter and one of supraventricular tachycardia) are described. Transplacental digitalisation was attempted in three cases. Supraventricular tachycardia associated with hydrops fetalis, detected in a fetus at a gestation of 31 weeks, was successfully converted to normal sinus rhythm eight days after the mother began treatment with digoxin. The serum concentration of digoxin in cord blood almost equalled the maternal concentration in three cases. In the remaining three cases treatment with digitalis was effective in converting tachyarrhythmias to sinus rhythm after delivery. With maintenance digoxin therapy, the prognosis of fetal tachyarrhythmias seems to be good, once conversion to sinus rhythm has been accomplished.

Topics: Atrial Flutter; Digoxin; Echocardiography; Female; Fetal Diseases; Humans; Infant, Newborn; Male; Maternal-Fetal Exchange; Pregnancy; Prenatal Diagnosis; Tachycardia, Supraventricular

Topics: Adult; Digoxin; Edema; Female; Fetal Diseases; Humans; Male; Maternal-Fetal Exchange; Pregnancy; Tachycardia, Supraventricular