Is digoxin still justifiable as single first-line therapy in fetal supraventricular tachyarrhythmias associated with fetal hydrops?

As long as there is no unanimity in the approach to the drug treatment of fetal tachycardia, digoxin continues to be the most commonly used first-line antiarrhythmic drug. Flecainide, sotalol and amiodarone have emerged as effective second-line treatment after digoxin failure both in nonhydropic and hydropic fetuses. We report five consecutive cases with fetal tachyarrhythmias complicated by hydrops diagnosed and treated in our center between 25 and 28 weeks of gestation (2002–2007). Four fetuses were started on transplacental digoxin whereas one fetus was treated with flecainide alone. The latter resulted in su…