Intracardiac adenosine triphosphate for cardioversion of supraventricular tachycardia in a hydropic foetus: a case report

Foetal supraventricular tachycardia (SVT) can cause foetal hydrops and demise if untreated. Transplacental therapy often fails in severe SVT with foetal hydrops due to impaired placental drug transfer. In the present study, we report the first successful cardioversion of recalcitrant SVT in a hydropic foetus by intracardiac adenosine triphosphate (ATP) administration.

A 34-year-old woman at 28 + 6 weeks of gestation was admitted for persistent foetal tachycardia, subsequently diagnosed as foetal SVT. After combined transplacental therapy with digoxin and sotalol, the foetal tachycardia remained uncontrolled, with progressive hydrops and deteriorating cardiac function. Ultimately, intracardiac ATP administration was performed and achieved successful cardioversion of the foetal SVT. No procedure-related complications occurred. After the procedure, maternal oral digoxin and sotalol were continued to maintain foetal sinus rhythm.

Intracardiac ATP administration offers a last-resort salvage therapy for terminating recalcitrant SVT with foetal hydrops, which should be reserved for highly selected patients and performed at specialized centres. The larger studies with longer follow-up are needed to validate this procedure’s efficacy and safety.