Key result
A higher-than-standard target serum level of digoxin (>2.0 ng/mL) successfully achieved sinus conversion of fetal atrial flutter (initial ventricular rate 214 bpm) in a monochorionic diamniotic twin.
Why the study?
The optimal digoxin serum target level for neonatal atrial flutter management remains uncertain, with standard target levels set between 1.0 and 2.0 ng/mL due to potential toxicity concerns.
Case Report (n=1)
A higher target serum level of digoxin may be necessary to achieve sinus conversion for fetal atrial flutter in MCDA twin pregnancies.
May support higher digoxin targets in refractory fetal atrial flutter; leaves open prospective validation in MCDA twins.
Background: Atrial flutter is an infrequent yet potentially fatal arrhythmia. Digoxin is the preferred first-line treatment for fetal atrial flutter due to its efficacy and favorable safety profile. The optimal digoxin serum target level for neonatal atrial flutter management remains uncertain, with the standard target level ranging from 1.0 to 2.0 ng/mL due to potential toxicity concerns above this threshold. Case Presentation: We present a case of atrial flutter in a fetus within a monochorionic diamniotic (MCDA) twin pregnancy that was successfully managed using a higher-than-standard target level of digoxin. A 34-year-old nulliparous woman was referred to our institution at 31 + 3 weeks of gestation due to fetal distress in an MCDA twin pregnancy. Fetal echocardiography revealed a ventricular rate of 214 bpm in twin A, while twin B exhibited no abnormal findings. Conclusions: Our case highlights a distinct correlation between the serum digoxin level and its impact on atrial flutter. A higher target serum level of digoxin may be necessary to achieve sinus conversion due to the unique maternal and fetal circulatory characteristics in MCDA pregnancies.
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Kim et al. (2023) conducted a case report in Fetal atrial flutter in a monochorionic diamniotic twin pregnancy (n=1). Digoxin was evaluated on Sinus conversion. A higher-than-standard target serum level of digoxin (>2.0 ng/mL) successfully achieved sinus conversion of fetal atrial flutter (initial ventricular rate 214 bpm) in a monochorionic diamniotic twin.
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