Key result
Maternal administration of digoxin followed by propafenone successfully reversed fetal atrial flutter, with subsequent neonatal stabilization using amiodarone and propafenone.
Case Report (n=1)
No
Propafenone can be used as an adjunct to digoxin for fetal atrial flutter when standard antiarrhythmics like sotalol or amiodarone are contraindicated due to maternal bradycardia and hypotension.
May support propafenone adjunct to digoxin for fetal atrial flutter when other agents are contraindicated; leaves open need for prospective validation.
Fetal tachycardia occurs in 0.4 0.6% of all pregnancies. Out of the sustained fetal tachyarrhythmias, the atrial flutter is the second most common. It causes fetal heart failure when not properly treated, and early pregnancy interruption may be required. The diagnosis of tachyarrhythmias is mainly achieved by intra-uterus echocardiography. The first choice treatment is the maternal oral administration of digoxin. The association with other antiarrhythmics such as sotalol or amiodarone is needed if there is no response to digoxin or if the fetus evolves with dropsy. In this case report, the treatment began with digoxin and because there was no response, it was associated with propafenone. Sotalol or amiodarone were not used due to maternal bradycardia and hypotension.
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Miranda et al. (2015) conducted a case report in Fetal atrial flutter (n=1). Digoxin and Propafenone was evaluated on Reversion of fetal atrial flutter. Maternal administration of digoxin followed by propafenone successfully reversed fetal atrial flutter, with subsequent neonatal stabilization using amiodarone and propafenone.
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