Reactions 1704, p27 - 2 Jun 2018
Left bundle branch block following in-utero
exposure : case report
A female neonate [exact age at event onset not stated]
developed left bundle branch block following in-utero
exposure to sotalol and amiodarone [duration of treatment to
reaction onset not stated].
The female neonate’s 23-year-old mother was referred at
20-3/7 weeks gestational age of her second pregnancy due to
fetal tachycardia and hydrops fetalis. Examinations led to the
diagnosis of junctional ectopic tachycardia (JET) in the fetus.
Subsequently, the fetus received treatment with transplacental
digoxin and sotalol (maximum dose 480 mg/day). At
28-4/7 weeks gestational age, sotalol and digoxin were
discontinued and oral amiodarone (600mg every 8 hours for
24 hours followed by 300mg every 12 hours) was given to her
mother. At 38-1/7 weeks gestational age, the mother delivered
the female neonate weighing 2.654kg through caesarean
section. The APGAR scores were nine at both one and five
minutes. An ECG showed junctional rhythm with rate of
115 bpm and left bundle branch block with QRS duration of
102ms. Brief periods of 2:1 AV block were observed during
sleep. Additionally, the neonate developed moderate
pulmonary hypertension, which was considered as related to
her underlying condition.
The female neonate was treated with propranolol, but the
QRS remained prolonged for the following two days. The QRS
duration normalised to 58ms by the second day of life, and the
neonate achieved sustained sinus rhythm. She also received
oxygen, which led to resolution of her pulmonary
hypertension. She was discharged home on day of life 5. Three
months later, she remained in sinus rhythm.
Author comment: "Drugs used to treat fetal JET
(flecainide, sotalol, and amiodarone) may produce transient
left bundle branch block in the newborn."
Zaidi SJ, et al. Prenatal diagnosis and management of junctional ectopic
tachycardia. HeartRhythm Case Reports 3: 503-508, No. 11, Nov 2017. Available
from: URL: http://doi.org/10.1016/j.hrcr.2017.07.022 - USA
Reactions 2 Jun 2018 No. 17040114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved