?url_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rft.title=Fetal+Tachyarrhythmia+-+Part+II%3A+Treatment&rft.creator=Oudijk%2C+Martijn+A&rft.creator=Visser%2C+Gerard+HA&rft.creator=Meijboom%2C+Erik+J&rft.subject=Indian+Pacing+and+Electrophysiology+Journal&rft.description=The+decision+to+initiate+pharmacological+intervention+in+case+of+fetal+tachycardia+depends+on+several+factors+and+must+be+weighed+against+possible+maternal+and%2For+fetal+adverse+effects+inherent+to+the+use+of+antiarrhythmics.+First%2C+the+seriousness+of+the+fetal+condition+must+be+recognized.+Many+studies+have+shown+that+in+case+of+fetal+tachycardia%2C+there+is+a+significant+predisposition+to+congestive+heart+failure+and+subsequent+development+of+fetal+hydrops+and+even+sudden+cardiac+death1%2C2%2C3+Secondly%2C+predictors+of+congestive+heart+failure+have+been+suggested+in+several+studies%2C+such+as+the+percentage+of+time+that+the+tachycardia+is+present%2C+the+gestational+age+at+which+the+tachycardia+occurs4%2C+the+ventricular+rate5+and+the+site+of+origin+of+the+tachycardia6.+However%2C+the+sensitivity+of+these+predictors+is+low+and+they+are+therefore+clinically+not+very+useful.+In+addition%2C+hemodynamic+compromise+may+occur+in+less+than+24+-+48+hours+as+has+been+shown+in+the+fetal+lamb7+and+in+tachycardic+fetuses8%2C9.+On+the+other+hand%2C+spontaneous+resolution+of+the+tachycardia+has+also+been+described10.+Thirdly%2C+transplacental+management+of+fetuses+with+tricuspid+regurgitation11%2C+congestive+heart+failure+or+fetal+hydrops+is+difficult12%2C13%2C+probably+as+a+result+of+limited+transplacental+transfer+of+the+antiarrhythmic+drug14%2C15.+In+case+of+fetal+hydrops%2C+conversion+rates+are+decreased+and+time+to+conversion+is+increased13.+Treatment+of+sustained+fetal+tachycardia+is+therefore+to+be+preferred+above+expectant+management%2C+although+some+centers+oppose+this+regimen+and+suggest+that+in+cases+with+(intermittent)+fetal+SVT+not+complicated+by+congestive+heart+failure+or+fetal+hydrops%2C+conservative+management+and+close+surveillance+might+be+a+reasonable+alternative16%2C17%2C18.+&rft.publisher=Indian+Pacing+and+Electrophysiology+Group&rft.contributor=Singh%2C+Balbir&rft.contributor=Lokhandwala%2C+Yash&rft.contributor=Francis%2C+Johnson&rft.contributor=Gupta%2C+Anup&rft.date=2004-10&rft.type=Journal+(Paginated)&rft.type=PeerReviewed&rft.format=application%2Fpdf&rft.identifier=http%3A%2F%2Fcogprints.org%2F4183%2F1%2Foudijk2.pdf&rft.identifier=++Oudijk%2C+Martijn+A+and+Visser%2C+Gerard+HA+and+Meijboom%2C+Erik+J++(2004)+Fetal+Tachyarrhythmia+-+Part+II%3A+Treatment.++%5BJournal+(Paginated)%5D+++++&rft.relation=http%3A%2F%2Fcogprints.org%2F4183%2F