Uncorrected Author Proof Journal of Neonatal-Perinatal Medicine xx (20xx) x–xx DOI:10.3233/NPM-190268 IOS Press 1 Case Report 1 Sotalol as an effective adjunct therapy in the management of supraventricular tachycardia induced fetal hydrops fetalis 2 3 4 M. Refaat a , J. El Dick a , M. Sabra a , F. Bitar b , C. Tayeh b and M. Arabi b,* 5 a Department of Internal Medicine, American University of Beirut Medical Center, Division of Cardiology, Beirut, Lebanon 6 7 b Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon 8 9 Received 1 April 2019 10 Revised 1 October 2019 11 Accepted 8 October 2019 12 Abstract. Sustained fetal supraventricular tachycardia (SVT) complicated by hydrops fetalis carries a significant risk of morbidity and mortality. While there is no clear consensus on first- and second-line therapy options for the management of fetal SVT with or without hydrops fetalis, there exists significant nonrandomized experience with a number of antiarrhythmic agents that has founded the basis for management. Furthermore, recently published meta-analyses and ongoing multicenter prospective studies have aimed to bridge the gap in the literature. We report two cases of sustained fetal SVT with severe secondary hydrops fetalis managed successfully with flecainide-sotalol combination therapy in one case and sotalol-digoxin combination therapy in the second and review the literature for the management of fetal SVT. 13 14 15 16 17 18 19 Keywords: Hydrops fetalis, supraventricular tachycardia, sotalol 20 Abbreviations 21 SVT supraventricular tachycardia AVRT atrial reentrant tachycardia AET atrial ectopic tachycardia PJRT permanent junctional reciprocating tachycardia AUBMC American University of Beirut Medical Center * Address for correspondence: Mariam Arabi, MD, Pediatri- cian, Pediatric Cardiologist, Director of In and Outpatient clinical services, Head, Fetal Heart Program – Children’s Heart Center American University of Beirut Medical Center Depart- ment of Pediatrics and Adolescent Medicine, Riad El Solh 1107 2020, Beirut, 11-0236, Lebanon. Tel.: 00961 1 374 374/ Ext: 5872/5881/5889; Fax: 00961 1 370 781; E-mail: ma81@aub.edu.lb. Bpm beats/minute Mg milligrams EKGs electrocardiograms HR heart rate SR sinus rhythm FDA The United States Food and Drug Administration 1. Introduction 22 Hydrops fetalis is classically described as the pres- 23 ence of excessive fluid accumulation in at least two 24 fetal body cavities and based on etiology can be 25 divided into two forms; immune-mediated and non- 26 immune mediated [1, 2]. Immune-mediated hydrops 27 1934-5798/19/$35.00 © 2019 – IOS Press and the authors. All rights reserved