Amiodarone given by three routes to terminate fetal atrial flutter associated with severe hydrops

BACKGROUND: We describe the concurrent administration of amiodarone using three different routes in order to provide: 1) rapid and adequate fetal loading without giving unduly high doses to the mother, and 2) a maintenance dose to the fetus without risking repeated invasive procedures. CASE: Rapid atrial flutter was seen on ultrasound in a fetus with severe hydrops at 27 weeks' gestation. Following failed transplacental therapy with sotalol and flecainide, amiodarone was administered to the fetus via the intravenous, intraperitoneal, and transplacental routes. Conversion to sinus rhythm and resolution of hydrops followed this treatment. CONCLUSION: Combined triple-route administration of amiodarone to the fetus can be effective in treating supraventricular tachycardia and may have a role in the management of life-threatening fetal arrhythmias refractory to transplacental therapy.