{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:43:14Z","timestamp":1790073794081,"version":"4.0.1"},"reference-count":39,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T00:00:00Z","timestamp":1643760000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine, Pharmacy, Science and Technology &quot; George Emil Palade&quot; of Targu Mures","award":["10126\/4\/17.12.2020"],"award-info":[{"award-number":["10126\/4\/17.12.2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Sustained fetal tachycardias are rare but represent a high risk of mortality and morbidity. Consensus has yet to be found regarding their optimal management. The aim of this narrative review is to summarize the data available in the current literature regarding the efficacy and safety of medications used in the management of intrauterine tachyarrhythmias and to provide possible treatment protocols. In this review, we would like to emphasize the importance of a thorough evaluation of both the fetus and the mother, prior to transplacental antiarrhythmic drug initiation. Factors such as the hemodynamic status of the fetus, possible mechanisms of fetal arrhythmia, and concomitant maternal conditions are of primordial importance. As a possible treatment protocol, we would like to recommend the following: due to the risk of sustained supraventricular tachycardia (SVT), fetuses with frequent premature atrial beats should be evaluated more frequently by echocardiography. A careful hemodynamic evaluation of a fetus with tachycardia is primordial in forestalling the appearance of hydrops. In the case of atrial flutter (AFL), sotalol therapy could represent a first choice, whereas when dealing with SVT patients, flecainide should be considered, especially for hydropic patients. These data require consolidation through larger scale, non-randomized studies and should be handled with caution.<\/jats:p>","DOI":"10.3390\/jcm11030804","type":"journal-article","created":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T05:42:33Z","timestamp":1643866953000},"page":"804","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Fetal Tachyarrhythmia Management from Digoxin to Amiodarone\u2014A Review"],"prefix":"10.3390","volume":"11","author":[{"given":"Liliana","family":"Gozar","sequence":"first","affiliation":[{"name":"Department of Pediatrics, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu-Mure\u0219, 540139 T\u00e2rgu-Mure\u0219, Romania"},{"name":"Pediatric Cardiology, Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorottya","family":"Gabor-Miklosi","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodica","family":"Toganel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu-Mure\u0219, 540139 T\u00e2rgu-Mure\u0219, Romania"},{"name":"Pediatric Cardiology, Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amalia","family":"Fagarasan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu-Mure\u0219, 540139 T\u00e2rgu-Mure\u0219, Romania"},{"name":"Pediatric Cardiology, Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horea","family":"Gozar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu-Mure\u0219, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Toma","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu-Mure\u0219, 540139 T\u00e2rgu-Mure\u0219, Romania"},{"name":"Pediatric Cardiology, Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4321-6229","authenticated-orcid":false,"given":"Andreea","family":"Cerghit-Paler","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, \u201cGeorge Emil Palade\u201d University of Medicine, Pharmacy, Science, and Technology of T\u00e2rgu-Mure\u0219, 540139 T\u00e2rgu-Mure\u0219, Romania"},{"name":"Pediatric Cardiology, Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 T\u00e2rgu-Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e007164","DOI":"10.1161\/JAHA.117.007164","article-title":"First-Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta-Analysis","volume":"6","author":"Alsaied","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1046\/j.1469-0705.1991.01030162.x","article-title":"Fetal tachyarrhythmias: Transplacental and direct treatment of the fetus-a report of 60 cases","volume":"1","author":"Hansmann","year":"1991","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1136\/heart.89.8.913","article-title":"Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia","volume":"89","author":"Krapp","year":"2003","journal-title":"Heart"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1016\/0735-1097(96)00054-X","article-title":"Fetal tachycardia: Mechanisms and predictors of hydrops fetalis","volume":"27","author":"Naheed","year":"1996","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1080\/14767050802488220","article-title":"An expanded phenotype of maternal SSA\/SSB antibody-associated fetal cardiac disease","volume":"22","author":"Cuneo","year":"2009","journal-title":"J. Matern. Neonatal Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1136\/hrt.79.2.195","article-title":"Familial atrial fibrillation with fetal onset","volume":"79","author":"Tikanoja","year":"1998","journal-title":"Heart"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1161\/01.CIR.81.5.1544","article-title":"Evolving concepts in the management of congenital junctional ectopic tachycardia. A multicenter study","volume":"81","author":"Villain","year":"1990","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.hrthm.2004.11.016","article-title":"Congenital junctional ectopic tachycardia and congenital complete atrioventricular block: A shared etiology?","volume":"2","author":"Dubin","year":"2005","journal-title":"Heart Rhythm"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jacc.2007.06.060","article-title":"Electrophysiological Characteristics of Fetal Atrioventricular Block","volume":"51","author":"Zhao","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1002\/uog.2819","article-title":"Fetal arrhythmias","volume":"27","author":"Simpson","year":"2006","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.earlhumdev.2006.05.020","article-title":"PR interval: A comparison of electrical and mechanical methods in the fetus","volume":"83","author":"Pasquini","year":"2007","journal-title":"Early Hum. Dev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1136\/heart.89.10.1211","article-title":"Management of fetal tachyarrhythmia based on superior vena cava\/aorta Doppler flow recordings","volume":"89","author":"Fouron","year":"2003","journal-title":"Heart"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1161\/01.CIR.0000031571.92807.CC","article-title":"Use of Tissue Velocity Imaging in the Diagnosis of Fetal Cardiac Arrhythmias","volume":"106","author":"Rein","year":"2002","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1046\/j.1469-0705.1991.01040286.x","article-title":"Electrophysiological principles and fetal antiarrhythmic therapy","volume":"1","author":"Kleinman","year":"1991","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1179\/2047480615Z.000000000329","article-title":"Writing narrative style literature reviews","volume":"24","author":"Ferrari","year":"2015","journal-title":"Med. Writ."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1136\/hrt.79.6.576","article-title":"Fetal tachycardias: Management and outcome of 127 consecutive cases","volume":"79","author":"Simpson","year":"1998","journal-title":"Heart"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1002\/pd.542","article-title":"Fetal supraventricular tachycardia: A role for amiodarone as second-line therapy?","volume":"23","author":"Jouannic","year":"2003","journal-title":"Prenat. Diagn."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1161\/CIRCULATIONAHA.111.026120","article-title":"Comparison of Transplacental Treatment of Fetal Supraventricular Tachyarrhythmias with Digoxin, Flecainide, and Sotalol","volume":"124","author":"Jaeggi","year":"2011","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1080\/14767058.2017.1286317","article-title":"Flecainide as first-line treatment for fetal supraventricular tachycardia","volume":"31","author":"Ekiz","year":"2017","journal-title":"J. Matern. Neonatal Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1161\/01.cir.0000437597.44550.5d","article-title":"Diagnosis and Treatment of Fetal Cardiac Disease","volume":"129","author":"Donofrio","year":"2014","journal-title":"Circulation"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1016\/j.hrthm.2016.03.023","article-title":"Flecainide versus digoxin for fetal supraventricular tachycardia: Comparison of two drug treatment protocols","volume":"13","author":"Sridharan","year":"2016","journal-title":"Heart Rhythm"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1177\/1753495X18808118","article-title":"Maternal monitoring and safety considerations during antiarrhythmic treatment for fetal supraventricular tachycardia","volume":"12","author":"Gandhi","year":"2019","journal-title":"Obstet. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1016\/j.jacc.2019.06.024","article-title":"Antenatal Therapy for Fetal Supraventricular Tachyarrhythmias","volume":"74","author":"Miyoshi","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2721","DOI":"10.1161\/01.CIR.101.23.2721","article-title":"Sotalol in the treatment of fetal dysrhythmias","volume":"101","author":"Oudijk","year":"2000","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1002\/uog.12390","article-title":"Sotalol as first-line treatment for fetal tachycardia and neonatal follow-up","volume":"42","author":"Oudijk","year":"2013","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1016\/j.hrthm.2014.07.031","article-title":"Correlation of maternal flecainide concentrations and therapeutic effect in fetal supraventricular tachycardia","volume":"11","author":"Vigneswaran","year":"2014","journal-title":"Heart Rhythm"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1161\/01.CIR.0000109494.05317.58","article-title":"Amiodarone Therapy for Drug-Refractory Fetal Tachycardia","volume":"109","author":"Strasburger","year":"2004","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1016\/j.hrthm.2016.01.029","article-title":"High-dose flecainide is the most effective treatment of fetal supraventricular tachycardia","volume":"13","author":"Strizek","year":"2016","journal-title":"Heart Rhythm"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1016\/j.amjcard.2012.01.388","article-title":"Effectiveness of Sotalol as First-Line Therapy for Fetal Supraventricular Tachyarrhythmias","volume":"109","author":"Shah","year":"2012","journal-title":"Am. J. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1111\/jce.14406","article-title":"Low mortality in fetal supraventricular tachycardia: Outcomes in a 30-year single-institution experience","volume":"31","author":"Alexander","year":"2020","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Broom, E., Thomas, J.T., Petersen, S., Gooi, A., Ward, C., Gardener, G., Kostner, K., Lee-Tannock, A., and Kumar, S. (2021). Management of Fetal Supraventricular Tachycardia: Case Series from a Tertiary Perinatal Cardiac Center. Fetal Diagn. Ther., 1\u20137.","DOI":"10.1159\/000519911"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1002\/jcu.1870130406","article-title":"Treatment of fetal supraventricular tachyarrhythmias","volume":"13","author":"Kleinman","year":"1985","journal-title":"J. Clin. Ultrasound"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1136\/bmj.297.6641.107","article-title":"Obstetric importance, diagnosis, and management of fetal tachycardias","volume":"297","author":"Maxwell","year":"1988","journal-title":"BMJ"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e016597","DOI":"10.1136\/bmjopen-2017-016597","article-title":"Antenatal antiarrhythmic treatment for fetal tachyarrhythmias: A study protocol for a prospective multicentre trial","volume":"7","author":"Miyoshi","year":"2017","journal-title":"BMJ Open"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1017\/S1047951109990497","article-title":"Diagnosis, clinical features, management, and post-natal follow-up of fetal tachycardias","volume":"19","author":"Podnar","year":"2009","journal-title":"Cardiol. Young"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1002\/pd.5144","article-title":"Transplacental treatment of fetal tachycardia: A systematic review and meta-analysis","volume":"37","author":"Hill","year":"2017","journal-title":"Prenat. Diagn."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1055\/s-2007-994432","article-title":"Fetal Supraventricular Tachycardia Complicated by Hydrops Fetalis: A Role for Direct Fetal Intramuscular Therapy","volume":"13","author":"Parilla","year":"1996","journal-title":"Am. J. Perinatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1055\/s-0034-1372430","article-title":"Diagnosis and Treatment of Fetal Arrhythmia","volume":"31","author":"Cuneo","year":"2014","journal-title":"Am. J. Perinatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.ejogrb.2020.11.055","article-title":"Maternal effects induced by oral digoxin during treatment of fetal tachyarrhythmia: Case series and literature review","volume":"256","author":"Chimenea","year":"2021","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/3\/804\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:13:11Z","timestamp":1760134391000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/3\/804"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,2]]},"references-count":39,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["jcm11030804"],"URL":"https:\/\/doi.org\/10.3390\/jcm11030804","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,2]]}}}