Pediatric Drugs

, Volume 4, Issue 1, pp 49–63 | Cite as

Drug Treatment of Fetal Tachycardias

  • Martijn A. Oudijk
  • Jopje M. Ruskamp
  • Barbara E. Ambachtsheer
  • Tessa F. F. Ververs
  • Philip Stoutenbeek
  • Gerard H. A. Visser
  • Erik J. Meijboom
Review Article


The pharmacological treatment of fetal tachycardia (FT) has been described in various publications. We present a study reviewing the necessity for treatment of FT, the regimens of drugs used in the last two decades and their mode of administration.

The absence of reliable predictors of fetal hydrops (FH) has led most centers to initiate treatment as soon as the diagnosis of FT has been established, although a small minority advocate nonintervention. As the primary form of pharmacological intervention, oral maternal transplacental therapy is generally preferred.

Digoxin is the most common drug used to treat FT; however, effectiveness remains a point of discussion. After digoxin, sotalol seems to be the most promising agent, specifically in atrial flutter and nonhydropic supraventricular tachycardia (SVT). Flecainide is a very effective drug in the treatment of fetal SVT, although concerns about possible pro-arrhythmic effects have limited its use. Amiodarone has been described favorably, but is frequently excluded due to its poor tolerability. Verapamil is contraindicated as it may increase mortality. Conclusions on other less frequently used drugs cannot be drawn.

In severely hydropic fetuses and/or therapy-resistant FT, direct fetal therapy is sometimes initiated. To minimize the number of invasive procedures, fetal intramuscular or intraperitoneal injections that provide a more sustained release are preferred.

Based on these data we propose a drug protocol of sotalol 160mg twice daily orally, increased to a maximum of 480mg daily. Whenever sinus rhythm is not achieved, the addition of digoxin 0.25mg three times daily is recommended, increased to a maximum of 0.5mg three times daily. Only in SVT complicated by FH, either maternal digoxin 1 to 2mg IV in 24 hours, and subsequently 0.5 to 1 mg/day IV, or flecainide 200 to 400 mg/day orally is proposed. Initiating direct fetal therapy may follow failure of transplacental therapy.


Digoxin Amiodarone Sotalol Disopyramide Flecainide 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used in the preparation of this manuscript and the authors acknowledge there are no conflicts of interest.


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Copyright information

© Adis International Limited 2002

Authors and Affiliations

  • Martijn A. Oudijk
    • 1
  • Jopje M. Ruskamp
    • 2
  • Barbara E. Ambachtsheer
    • 2
  • Tessa F. F. Ververs
    • 3
  • Philip Stoutenbeek
    • 1
  • Gerard H. A. Visser
    • 1
  • Erik J. Meijboom
    • 2
  1. 1.Department of ObstetricsUniversity Medical CenterUtrechtThe Netherlands
  2. 2.Department of CardiologyUniversity Medical Center (UMC), KG 01.3190UtrechtThe Netherlands
  3. 3.Division of Hospital PharmacyUniversity Medical CenterUtrechtThe Netherlands

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