Intrauterine treatment and outcome of fetal persistent atrial flutter: a case report

Abstract Background: Fetal atrial flutter (AF) accounts for 30% of all fetal tachyarrhythmias, and more than 80% of fetal atrial flutter is 2:1 atrioventricular conduction. When a severe persistent arrhythmia occurs, intrauterine therapy is the first choice, and childbirth is not the first choice. Case presentation: A 32-year-old Chinese multipara at 30+2 weeks of gestation whose ultrasonographic examination revealed fetal persistent atrial flutter (atrial rate 219-445 beats/min, ventricular rate 219-228 beats/min, 2:1 or 1:1 down transmission) and a small amount of ascites. The fetal heart rhythm did not recover even after oral administration of digoxin and sotalol to the gravida. At 32+3 weeks of gestation, the fetal intramuscular injection of celanide was administered under the guidance of ultrasound. The fetal ventricular rate decreased 6 days after operation and the ascites disappeared. At 33+3 weeks, due to the poor tolerance of the gravida to the drugs, the infant was delivered by cesarean section. 5 minutes after birth, the infant heart rhythm was spontaneously converted to sinus rhythm. Follow-up to 1 year after birth, the infant hasn't had atrial flutter. Conclusions: In this case, the fetal heart rhythm automatically reverted to sinus rhythm after birth which appears that when the transplacental drug treatment failed, intrauterine treatment of the drug should be considered. And the prognosis of fetal atrial flutter is optimistic.