Prospective Randomized Clinical Trial of Fetal Atrial Flutter & Supraventricular Tachycardia Therapy (FAST RCT)
Fetal Atrial Flutter Without Hydrops, Fetal Supraventricular Tachycardia Without Hydrops, Fetal Supraventricular Tachycardia With Hydrops
About this trial
This is an interventional treatment trial for Fetal Atrial Flutter Without Hydrops focused on measuring RCT A: Fetal Atrial Flutter without Hydrops, RCT B: Fetal Supraventricular Tachycardia without Hydrops, RCT C: Fetal Supraventricular Tachycardia with Hydrops
Eligibility Criteria
Inclusion Criteria:
- Mother has provided written informed consent to participate
- Either fetal AF without hydrops, SVT without hydrops or SVT with hydrops
Tachyarrhythmia that is significant enough to justify immediate transplacental pharmacological treatment:
- Tachycardia ≥ 180 bpm during at least 10% of observation time of 30 minutes or longer
- Tachycardia ≥ 170 bpm during +100% of time (≤ 30 0/7 weeks of gestation)
- Tachycardia ≥ 280 bpm (irrespective of SVA duration)
- SVT with fetal hydrops (irrespective of duration)
- Gestational age > 12 0/7 weeks and <36 0/7 weeks at time of enrollment
- Untreated tachycardia at time of enrollment
- Singleton Pregnancy
Healthy mother with ± normal pre-treatment cardiovascular findings:
- ECG without significant abnormalities (sinus rhythm; QTc ≤ 0.47; PR ≤ 0.2 sec; QRS: ≤ 0.12 sec; isolated PACs or PVCs or isolated complete right bundle branch block allowed)
- Resting heart rate ≥ 50 bpm
- Systolic BP ≥ 85 bpm
Exclusion Criteria:
- AF with hydrops (eligible for FAST Registry only)
- Any maternal-fetal conditions associated with high odds of premature delivery or death other than tachycardia (e.g. severe IUGR; premature rupture of membrane; life-threatening maternal disease (incl. pre-eclampsia; HELLP syndrome); severe congenital fetal abnormalities (T 13 or 18; surgery or death expected < 1 month)
- History of significant maternal heart condition (open heart surgery; sick sinus syndrome; channelopathy (long QT, Brugada syndrome); ventricular tachycardia; WPW syndrome; high-degree heart block; cardiomyopathy)
- Relevant preexisting maternal obstructive airway disease including asthma
Current therapy with the following medications:
- Antiarrhythmic drugs
- Pentamidine
- Maternal serum potassium level <3.3 mmol/L / <3.3 mEq/L (at start of treatment)
- Maternal ionized serum calcium level of <1 mmol/L / <4 mg/dL) or total serum calcium level <2 mmol/L / <8mg/dL (at start of treatment)
- Maternal serum creatinine level > 97.2 µmol/L (>1.1 mg/dl)
Sites / Locations
- UCSF Benioff Children's HospitalRecruiting
- Children's Hospital of ColoradoRecruiting
- Children's National Health System
- Morgan Stanley Children's Hospital of New York-PresbyterianRecruiting
- Cohen Children's Medical CenterRecruiting
- Cincinnati Children's Hospital Medical CenterRecruiting
- Vanderbilt University Medical CenterRecruiting
- Pediatrix Medical Services, Inc,Recruiting
- Baylor College of MedicineRecruiting
- University of UtahRecruiting
- Children's Hospital of Richmond at VCU
- West Virginia University Research CorporationRecruiting
- Children's Hospital of WisconsinRecruiting
- Queensland Children's Hospital
- The Royal Women's HospitalRecruiting
- Perth Children's Hospital
- British Columbia Children's HospitalRecruiting
- University of Alberta/WCCHNRecruiting
- CHU Sainte-Justine HospitalRecruiting
- Mount Sinai HospitalRecruiting
- The Hospital for Sick ChildrenRecruiting
- UKB Universitätsklinikum BONNRecruiting
- Academic Medical Center - AMC
- Leiden University Medical Center - LUMCRecruiting
- Erasmus University Medical Center
- University Medical Center Utrecht
- Birmingham Women's and Children's NHS Foundation Trust
- Chelsea and Westminster Hospital NHS Foundation Trust
- St George's University Hospital Foundation Trust
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm 5
Arm 6
Active Comparator
Active Comparator
Active Comparator
Active Comparator
Active Comparator
Active Comparator
RCT A (1st arm): AF without hydrops
RCT A (2nd arm): AF without hydrops
RCT B (1st arm): SVT without hydrops
RCT B (2nd arm): SVT without hydrops
RCT C (1st arm): SVT with hydrops
RCT C (2nd arm): SVT with hydrops
Atrial Flutter (AF) without hydrops: Treatment with Digoxin as monotherapy.
Atrial Flutter (AF) without hydrops: Treatment with Sotalol as monotherapy.
Supraventricular Tachycardia (SVT) without hydrops: Treatment with Digoxin as monotherapy.
Supraventricular Tachycardia (SVT) without hydrops: Treatment with Flecainide as monotherapy.
Supraventricular Tachycardia (SVT) with hydrops: Treatment with Digoxin and Sotalol.
Supraventricular Tachycardia (SVT) with hydrops: Treatment with Digoxin and Flecainide.