Fetal Therapy for Severe Drug-Resisted Tachyarrhythmia With Progressive Hydrops by Fetoscopic Transesophageal Pacing: A Successful Attempt in Single Chinese Fetal Medicine Center

Objective: To describe the outcome of a case of severe drug-resistant fetal tachyarrhythmia with progressive hydrops treated with fetoscopic transesophageal pacing (FTEP).

Method: A case of fetal tachyarrhythmia complicated by progressive hydrops is presented. The fetus, diagnosed at 26⁺² weeks of gestation, had supraventricular tachycardia with a mechanism suggestive of atrial reentry. Maternal treatment included digoxin, sotalol and amiodarone, which were ineffective in controlling the arrhythmia. After failure of pharmacological therapy, FTEP was performed.

Results: A male baby was delivered by cesarean section, with the Apgar scores of 10 at 1 min, 5 and 10 min at 35⁺² weeks of gestation. An initial neonatal electrocardiogram demonstrated normal sinus rhythm. Follow-up is now up to 1 year, without tachyarrhythmia or cardiac dysfunction.

Conclusion: FTEP offers a potential rescue therapy for cases of severe drug-resistant fetal tachyarrhythmia associated with progressive fetal hydrops and cardiac dysfunction.