Antenatal Therapy for Fetal Supraventricular Tachyarrhythmias Multicenter Trial

被引：54

作者：

Miyoshi, Takekazu ^{[1
]}

Maeno, Yasuki ^{[2
]}

Hamasaki, Toshimitsu ^{[3
]}

Inamura, Noboru ^{[4
]}

Yasukochi, Satoshi ^{[5
]}

Kawataki, Motoyoshi ^{[6
]}

Horigome, Hitoshi ^{[7
]}

Yoda, Hitoshi ^{[8
]}

Taketazu, Mio ^{[9
]}

Nii, Masaki ^{[10
]}

Hagiwara, Akiko ^{[11
]}

Kato, Hitoshi ^{[12
]}

Shimizu, Wataru ^{[13
]}

Shiraishi, Isao ^{[14
]}

Sakaguchi, Heima ^{[14
]}

Ueda, Keiko ^{[1
]}

Katsuragi, Shinji ^{[1
]}

Yamamoto, Haruko ^{[15
]}

Sago, Haruhiko ^{[16
]}

Ikeda, Tomoaki ^{[17
]}

机构：

[1] Natl Cerebral & Cardiovasc Ctr, Dept Perinatol & Gynecol, Suita, Osaka, Japan

[2] Kurume Univ, Sch Med, Dept Pediat & Child Hlth, 67 Asahi Machi, Kurume, Fukuoka 8300011, Japan

[3] Natl Cerebral & Cardiovasc Ctr, Dept Data Sci, Suita, Osaka, Japan

[4] Osaka Womens & Childrens Hosp, Dept Pediat Cardiol, Izumi, Japan

[5] Nagano Childrens Hosp, Dept Cardiol, Azumino, Japan

[6] Tohoku Univ, Grad Sch Med, Dept Gynecol & Obstet, Sendai, Miyagi, Japan

[7] Univ Tsukuba, Dept Pediat, Tsukuba, Ibaraki, Japan

[8] Toho Univ, Omori Med Ctr, Dept Neonatol, Tokyo, Japan

[9] Saitama Med Univ, Int Med Ctr, Dept Pediat Cardiol, Hidaka, Japan

[10] Shizuoka Childrens Hosp, Dept Cardiol, Shizuoka, Japan

[11] Kanagawa Childrens Med Ctr, Dept Internal Med, Yokohama, Kanagawa, Japan

[12] Natl Ctr Child Hlth & Dev, Dept Pediat Cardiol, Tokyo, Japan

[13] Nippon Med Sch, Dept Cardiovasc Med, Tokyo, Japan

[14] Natl Cerebral & Cardiovasc Ctr, Dept Pediat Cardiol, Suita, Osaka, Japan

[15] Natl Cerebral & Cardiovasc Ctr, Dept Adv Med Technol Dev, Suita, Osaka, Japan

[16] Natl Ctr Child Hlth & Dev, Ctr Maternal Fetal Neonatal & Reprod Med, Tokyo, Japan

[17] Mie Univ, Dept Obstet & Gynecol, Tsu, Mie, Japan

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2019年 / 74卷 / 07期

关键词：

adverse event; atrial flutter; fetal echocardiography; fetal tachyarrhythmia; supraventricular tachycardia; transplacental treatment; ATRIAL-FLUTTER; TRANSPLACENTAL TREATMENT; INTRAUTERINE TREATMENT; TACHYCARDIA; MANAGEMENT; FLECAINIDE; DIAGNOSIS; DIGOXIN; SOTALOL;

D O I：

10.1016/j.jacc.2019.06.024

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Standardized treatment of fetal tachyarrhythmia has not been established. OBJECTIVES This study sought to evaluate the safety and efficacy of protocol-defined transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL). METHODS 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. RESULTS 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. CONCLUSIONS 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. (C) 2019 by the American College of Cardiology Foundation.

引用

页码：874 / 885

页数：12

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