{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T13:37:00Z","timestamp":1792157820190,"version":"4.4.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2011,10,18]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>Fetal tachyarrhythmia may result in low cardiac output and death. Consequently, antiarrhythmic treatment is offered in most affected pregnancies. We compared 3 drugs commonly used to control supraventricular tachycardia (SVT) and atrial flutter (AF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>\n                      We reviewed 159 consecutive referrals with fetal SVT (n=114) and AF (n=45). Of these, 75 fetuses with SVT and 36 with AF were treated nonrandomly with transplacental flecainide (n=35), sotalol (n=52), or digoxin (n=24) as a first-line agent. Prenatal treatment failure was associated with an incessant versus intermittent arrhythmia pattern (n=85; hazard ratio [HR]=3.1;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) and, for SVT, with fetal hydrops (n=28; HR=1.8;\n                      <jats:italic>P<\/jats:italic>\n                      =0.04). Atrial flutter had a lower rate of conversion to sinus rhythm before delivery than SVT (HR=2.0;\n                      <jats:italic>P<\/jats:italic>\n                      =0.005). Cardioversion at 5 and 10 days occurred in 50% and 63% of treated SVT cases, respectively, but in only 25% and 41% of treated AF cases. Sotalol was associated with higher rates of prenatal AF termination than digoxin (HR=5.4;\n                      <jats:italic>P<\/jats:italic>\n                      =0.05) or flecainide (HR=7.4;\n                      <jats:italic>P<\/jats:italic>\n                      =0.03). If incessant AF\/SVT persisted to day 5 (n=45), median ventricular rates declined more with flecainide (\u221222%) and digoxin (\u221213%) than with sotalol (\u22125%;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Flecainide (HR=2.1;\n                      <jats:italic>P<\/jats:italic>\n                      =0.02) and digoxin (HR=2.9;\n                      <jats:italic>P<\/jats:italic>\n                      =0.01) were also associated with a higher rate of conversion of fetal SVT to a normal rhythm over time. No serious drug-related adverse events were observed, but arrhythmia-related mortality was 5%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion\u2014<\/jats:title>\n                    <jats:p>Flecainide and digoxin were superior to sotalol in converting SVT to a normal rhythm and in slowing both AF and SVT to better-tolerated ventricular rates and therefore might be considered first to treat significant fetal tachyarrhythmia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.111.026120","type":"journal-article","created":{"date-parts":[[2011,9,20]],"date-time":"2011-09-20T04:41:29Z","timestamp":1316493689000},"page":"1747-1754","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":216,"title":["Comparison of Transplacental Treatment of Fetal Supraventricular Tachyarrhythmias With Digoxin, Flecainide, and Sotalol"],"prefix":"10.1161","volume":"124","author":[{"given":"Edgar T.","family":"Jaeggi","sequence":"first","affiliation":[{"name":"From the Hospital for Sick Children (E.T.J., B.W.M., C.M.) and Mount Sinai Hospital (G.R.), University of Toronto, Toronto, ON, Canada; Royal Brompton and St. George's Hospitals, London, UK (J.S.C., O.A.); Leiden University Medical Center, Leiden, the Netherlands (E.D.G., N.A.B.); Academic Medical Center, Amsterdam, the Netherlands (S.-A.B.C.); and Free University Medical Center, Amsterdam, the Netherlands (L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julene S.","family":"Carvalho","sequence":"additional","affiliation":[{"name":"From the Hospital for Sick Children (E.T.J., B.W.M., C.M.) and Mount Sinai Hospital (G.R.), University of Toronto, Toronto, ON, Canada; Royal Brompton and St. George's Hospitals, London, UK (J.S.C., O.A.); Leiden University Medical Center, Leiden, the Netherlands (E.D.G., N.A.B.); Academic Medical Center, Amsterdam, the Netherlands (S.-A.B.C.); and Free University Medical Center, Amsterdam, the Netherlands (L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernestine","family":"De Groot","sequence":"additional","affiliation":[{"name":"From the Hospital for Sick Children (E.T.J., B.W.M., C.M.) and Mount Sinai Hospital (G.R.), University of Toronto, Toronto, ON, Canada; Royal Brompton and St. George's Hospitals, London, UK (J.S.C., O.A.); Leiden University Medical Center, Leiden, the Netherlands (E.D.G., N.A.B.); Academic Medical Center, Amsterdam, the Netherlands (S.-A.B.C.); and Free University Medical Center, Amsterdam, the Netherlands (L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olus","family":"Api","sequence":"additional","affiliation":[{"name":"From the Hospital for Sick Children (E.T.J., B.W.M., C.M.) and Mount Sinai Hospital (G.R.), University of Toronto, Toronto, ON, Canada; Royal Brompton and St. George's Hospitals, London, UK (J.S.C., O.A.); Leiden University Medical Center, Leiden, the Netherlands (E.D.G., N.A.B.); Academic Medical Center, Amsterdam, the Netherlands (S.-A.B.C.); and Free University Medical Center, Amsterdam, the Netherlands (L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally-Ann B.","family":"Clur","sequence":"additional","affiliation":[{"name":"From the Hospital for Sick Children (E.T.J., B.W.M., C.M.) and Mount Sinai Hospital (G.R.), University of Toronto, Toronto, ON, Canada; Royal Brompton and St. George's Hospitals, London, UK (J.S.C., O.A.); Leiden University Medical Center, Leiden, the Netherlands (E.D.G., N.A.B.); Academic Medical Center, Amsterdam, the Netherlands (S.-A.B.C.); and Free University Medical Center, Amsterdam, the Netherlands (L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Rammeloo","sequence":"additional","affiliation":[{"name":"From the Hospital for Sick Children (E.T.J., B.W.M., C.M.) and Mount Sinai Hospital (G.R.), University of Toronto, Toronto, ON, Canada; Royal Brompton and St. George's Hospitals, London, UK (J.S.C., O.A.); Leiden University Medical Center, Leiden, the Netherlands (E.D.G., N.A.B.); Academic Medical Center, Amsterdam, the Netherlands (S.-A.B.C.); and Free University Medical Center, Amsterdam, the Netherlands (L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian W.","family":"McCrindle","sequence":"additional","affiliation":[{"name":"From the Hospital for Sick Children (E.T.J., B.W.M., C.M.) and Mount Sinai Hospital (G.R.), University of Toronto, Toronto, ON, Canada; Royal Brompton and St. George's Hospitals, London, UK (J.S.C., O.A.); Leiden University Medical Center, Leiden, the Netherlands (E.D.G., N.A.B.); Academic Medical Center, Amsterdam, the Netherlands (S.-A.B.C.); and Free University Medical Center, Amsterdam, the Netherlands (L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Ryan","sequence":"additional","affiliation":[{"name":"From the Hospital for Sick Children (E.T.J., B.W.M., C.M.) and Mount Sinai Hospital (G.R.), University of Toronto, Toronto, ON, Canada; Royal Brompton and St. George's Hospitals, London, UK (J.S.C., O.A.); Leiden University Medical Center, Leiden, the Netherlands (E.D.G., N.A.B.); Academic Medical Center, Amsterdam, the Netherlands (S.-A.B.C.); and Free University Medical Center, Amsterdam, the Netherlands (L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cedric","family":"Manlhiot","sequence":"additional","affiliation":[{"name":"From the Hospital for Sick Children (E.T.J., B.W.M., C.M.) and Mount Sinai Hospital (G.R.), University of Toronto, Toronto, ON, Canada; Royal Brompton and St. George's Hospitals, London, UK (J.S.C., O.A.); Leiden University Medical Center, Leiden, the Netherlands (E.D.G., N.A.B.); Academic Medical Center, Amsterdam, the Netherlands (S.-A.B.C.); and Free University Medical Center, Amsterdam, the Netherlands (L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nico A.","family":"Blom","sequence":"additional","affiliation":[{"name":"From the Hospital for Sick Children (E.T.J., B.W.M., C.M.) and Mount Sinai Hospital (G.R.), University of Toronto, Toronto, ON, Canada; Royal Brompton and St. George's Hospitals, London, UK (J.S.C., O.A.); Leiden University Medical Center, Leiden, the Netherlands (E.D.G., N.A.B.); Academic Medical Center, Amsterdam, the Netherlands (S.-A.B.C.); and Free University Medical Center, Amsterdam, the Netherlands (L.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","first-page":"423","volume-title":"Textbook of Fetal Cardiology","author":"Simpson J","year":"2000","unstructured":"Simpson J. Fetal arrhythmias. In: , Allan L, Hornberger L, Sharland G eds. Textbook of Fetal Cardiology. 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Pharmacological and interventional fetal cardiovascular treatment. In: , Anderson RH, Baker EJ, Redington A, Rigby ML, Penny D, Wernovsky G eds. Paediatric Cardiology. 3rd ed. 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