Treatment of fetal SVT with digoxin and sotalol in a twin pregnancy can lead to severe bradycardia in the affected twin without altering the healthy twin's heart rate.
Urges caution with digoxin-sotalol for fetal SVT in twins; leaves open questions on selective effects and management.
The incidence of fetal arrhythmias is less than 1%. In 47-68% of cases, tachyarrhythmia is presented with supraventricular tachycardia (SVT) with heart rate ranges from 200-300 beats per minute. The mother is usually asymptomatic with no signs of fetal compromise. Fetal hydrops is associated with up to 64% of cases and may require more medications and a longer treatment period. This very rare condition has not been described in twin pregnancy yet. The authors present a case of supraventricular tachycardia in one twin with initial hydrops in 28th week of pregnancy. Considering gestational age, drug therapy was first treatment option. After administration of digoxin and sotalol, the twin with SVT presented with severe bradycardia (70-80 beats per minute). The heart rate of healthy twin remained normal. The pregnancy was terminated by cesarean section 24 hours later due to the onset of preterm labour.
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Gall et al. (2018) studied this question.
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