Can digoxin and sotalol therapy for fetal supraventricular tachycardia and hydrops be successful? A case report

BACKGROUND: Neonatal survival and prognosis are closely linked with development of hydrops in cases of sustained fetal tachycardia. Several antiarrhythmic medications are available for conversion to sinus rhythm. CASE: An 18-year-old woman had an audible fetal arrhythmia at 25 weeks' gestation. Fetal echocardiography revealed supraventricular tachycardia with worsening cardiac function at 28 weeks. Digoxin therapy was initiated and sotalol was later added for new-onset hydrops. The medications were then adjusted, and the fetus' heart rate converted to sinus rhythm with resolution of the hydrops. The patient was then managed as an outpatient with antenatal testing, serial laboratory studies and electrocardiograms until 39 weeks. CONCLUSION: Digoxin and Sotalol therapy can be successful in blocking likely nodal reentry in sustained fetal supraventricular tachycardia, thus allowing resolution of hydrops with a favorable outcome.