Perinatal Treatment of Refractory Atrial Flutter with Hydrops Fetalis: A Case Report
Suchaya Luewan MD*, Rekwan Sittiwangkul MD**, Kasemsri Srisupundit MD*, Theera Tongsong MD*
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ** Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Objective : Highlight the management of a critically ill premature hydropic baby with refractory atrial flutter (AF) and
successful outcome without neurologic sequel at 1 year of follow-up.
Case: A 23-year-old pregnant woman, G1P0, presented with fetal tachycardia at 32 weeks.
Results : Ultrasound revealed a hydropic fetus with fetal atrial rate (FHR) of 440 bpm and A:V block of 2:1. Transplacental
therapy resulted in a temporary response with the combination of digoxin and flecainide, and subsequently digoxin plus
sotalol. Termination of pregnancy at 34 weeks was performed for postnatal treatment, giving birth to a premature hydropic
baby, weighing 3,320 grams. At birth flecainide failed to control the AF. Therefore, intravenous adenosine was started and
successful conversion to normal sinus rhythm was temporally achieved. Finally, conversion to normal sinus rhythm with
amiodarone plus digoxin was satisfactorily achieved and then long-term control with only oral flecainide. The hydropic signs
gradually disappeared without any significant sequelae. The baby was healthy at one year of follow-up without any neurological
sequelae.
Conclusion : This case may be evidence that combined therapy with amiodarone and digoxin is probably effective in treatment
of refractory AF with hydropic changes, at least in some cases.
Keywords : Atrial flutter, Hydrops fetalis, Ultrasound
