Successful Treatment Of Fetal Atrial Flutter With Sotalol In A Non-Hydrops Fetalis

We presented a patient in whom atrial flutter was detected during the third trimester and who was first treated with digoxin but could not tolerate it; success was then achieved on treating the patient with sotalol. A 26-years-old primigravida patient was referred to our clinic with a prediagnosis of fetal tachycardia at 32nd weeks of pregnancy. Atrial rate was detected as 533 beats/minute and ventricular rate was found as 266 beats/minute during fetal echocardiography (ECG); a diagnosis of fetal atrial flutter was made. Patient was first treated with digoxin; digoxin treatment was interrupted because of nausea, vomiting, hypotension, epigastric pain, and changes in ECG, which were associated with digoxin. Treatment was continued with sotalol in the patient who could not tolerate digoxin. It was observed that fetal heart rate decreased and returned to sinus rhythm following sotalol treatment. Pregnancy was continued until term in a healthy manner. A baby boy with a weight of 2800 g and having an Apgar score of 9 at first min and a score of 10 at fifth min was delivered by vaginal delivery. No structural abnormality was detected in the newborn during ECG. Fetal ECG is a reliable method for the diagnosis and follow-up of fetal tachyarrhythmias. Digoxin is the first-line agent in the treatment of fetal arrhythmia, but second-line agents are required in patients who cannot tolerate digoxin at therapeutic levels and present digoxin-related adverse effects. Sotalol is a good second-line antiarrhythmic agent that can be used safely.