Top Things to Know: Pharmacological Management of Cardiac Arrhythmias in the Fetal and Neonatal Period
Prepared by Prepared by: Paul St. Laurent, DNP, RN, National Senior Director, Science and Medicine
- Fetal and neonatal arrhythmias occur in approximately 1 per 4,000 live births and are an important cause of morbidity and mortality, with supraventricular tachycardia (SVT) and atrial flutter (AFL) being the most common significant arrhythmias.
- Fetal arrhythmias are usually diagnosed early in pregnancy and require treatment in-utero to prolong gestation.
- Fetal arrhythmias can be treated with antiarrhythmic drug therapy to restore normal fetal heart rate, prevent/reverse fetal heart failure, and avoid premature delivery and its consequences.
- While there are no established strategies or algorithms for the management of these diverse arrhythmias, the goal is to identify best practices for antiarrhythmic treatments and to limit unnecessary and potentially toxic drug exposure in the fetus, neonate, and pregnant patient.
- In-patient management of fetal arrhythmias is necessary for the safety of both the mother and the fetus.
- Weekly fetal echocardiographic monitoring is an important tool for monitoring the side effects associated with antiarrhythmic therapy.
- Intravenous amiodarone and procainamide are effective therapies for refractory SVT but can lead to neonatal complications including thyroid dysfunction with amiodarone treatment.
- The pharmacokinetics of various drugs such as amiodarone, digoxin, flecainide, ivabradine, procainamide, and propranolol are different in neonates compared to adults, with some requiring higher doses due to the larger volume of distribution.
- Efforts are being made to evaluate treatments for fetal and neonatal arrhythmias, with multi-center approaches and collaborative studies being undertaken.
- Research is needed to further understand the pharmacokinetic properties of antiarrhythmic drugs in neonates. The use of quantum technology, pharmacogenomics, and induced pluripotent stem cell reprogramming could potentially lead to personalized medicine for fetal arrhythmias.
Citation
Batra AS, Silka MJ, Borquez A, Cuneo B, Dechert B, Jaeggi E, Kannankeril PJ, Tabulov C, Tisdale JE, Wolfe D; on behalf of the American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology; Council on Basic Cardiovascular Sciences; Council on Cardiovascular and Stroke Nursing; Council on Genomic and Precision Medicine; and Council on Lifelong Congenital Heart Disease and Heart Health in the Young. Pharmacological management of cardiac arrhythmias in the fetal and neonatal periods: a scientific statement from the American Heart Association. Circulation. Published online February 5, 2024. doi: 10.1161/CIR.0000000000001206