Postnatal Outcomes of Fetal Supraventricular Tachycardia: a Multicenter Study
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Supraventricular tachycardia (SVT), the most common fetal tachycardia, can be difficult to manage in utero. We sought to better understand predictors of the postnatal clinical course in neonates who experienced fetal SVT. We hypothesized that fetuses with hydrops or those with refractory SVT (failure of first-line SVT therapy) are more likely to experience postnatal SVT. This was a retrospective multicenter cohort study of subjects diagnosed with fetal SVT between 2006 and 2014. Fetuses with structural heart disease were excluded. Descriptive comparative statistics and univariate analysis with logistic regression were utilized to determine factors that most strongly predicted postnatal SVT and preterm delivery. The cohort consisted of 103 subjects. Refractory SVT was found in 37% (N = 38) of the cohort with this group more likely to be delivered prematurely (median = 36 vs. 37.5 weeks, p = 0.04). Refractory SVT did not increase the risk of postnatal SVT (p = 0.09). Postnatal SVT was seen in 61% (N = 63). Of those, 68% (N = 43) had postnatal SVT at ≤2 days of age. Postnatal SVT was associated with a later fetal SVT diagnosis (median = 30 vs. 27.5 weeks, p = 0.006). We found a strong correlation between postnatal SVT and later gestational age at fetal SVT diagnosis. Subjects with refractory SVT or hydrops did not have a higher risk of postnatal SVT. We propose strong consideration for term delivery in the absence of significant clinical compromise. Further studies to assess whether outcomes vary for preterm delivery versus expectant management in those with refractory SVT should be performed.
KeywordsSupraventricular tachycardia Clinical studies Fetal echocardiography
This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, the National Institutes of Health, through Grant 8UL1TR000105 (formerly UL1RR025764).
Compliance with Ethical Standards
Conflicts of Interest
Kevin Hinkle, Shabnam Peyvandi, Corey Stiver, Stacy A. S. Killen, Hsin Yi Weng, Susan P. Etheridge, Michael Puchalski declares no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 5.Jaeggi ET, Carvalho JS, De Groot E, Api O, Clur SA, Rammeloo L, McCrindle BW, Ryan G, Manlhiot C, Blom NA (2011) Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study. Circulation 124(16):1747–1754. doi: 10.1161/CIRCULATIONAHA.111.026120 CrossRefPubMedGoogle Scholar
- 14.Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381. doi: 10.1016/j.jbi.2008.08.010 CrossRefPubMedGoogle Scholar
- 16.Mathews TJ, MacDorman MF (2011) Infant mortality statistics from the 2007 period linked birth/infant death data set. Natl Vital Stat Rep 59(6):1–30Google Scholar
- 20.Hahurij ND, Gittenberger-De Groot AC, Kolditz DP, Bokenkamp R, Schalij MJ, Poelmann RE, Blom NA (2008) Accessory atrioventricular myocardial connections in the developing human heart: relevance for perinatal supraventricular tachycardias. Circulation 117(22):2850–2858. doi: 10.1161/CIRCULATIONAHA.107.756288 CrossRefPubMedGoogle Scholar
- 21.Kolditz DP, Wijffels MC, Blom NA, van der Laarse A, Markwald RR, Schalij MJ, Gittenberger-de Groot AC (2007) Persistence of functional atrioventricular accessory pathways in postseptated embryonic avian hearts: implications for morphogenesis and functional maturation of the cardiac conduction system. Circulation 115(1):17–26. doi: 10.1161/CIRCULATIONAHA.106.658807 CrossRefPubMedGoogle Scholar