VENTRICULAR TACHYCARDIA IN FETUS AND NEONATE: A SINGLE CENTRE EXPERIENCE

BACKGROUND Ventricular tachycardia (VT) is a very rare condition in the fetus and neonate, which can occur in the presence of structurally normal hearts, congenital heart disease (CHD), cardiomyopathy, or channelopathy. Overall there is a paucity of information about its management and outcomes in the literature METHODS AND RESULTS A single center retrospective study was performed. All fetuses and neonates with VT managed at the Stollery Children's Hospital between 2005-2020 were included. We recorded the age at diagnosis, presenting symptoms/features, associated syndromes, presence of CHD, presence of other medical diseases, diagnostic investigations, family history, management strategies, and length of stay in hospital. A total of 5 fetal and 8 neonatal cases were diagnosed with VT from 2005-2020. Two (40%) fetal compared to 5(62%) neonatal cases had CHD(p=0.59). Only 1/13, a fetus, had a cardiomyopathy with findings suggesting restriction prior to onset of VT. Median age at VT presentation was 32(26-37) weeks for fetal and 11(1-27) days for neonatal cases. Two fetuses were treated transplacentally with propranolol and two needed amiodarone. One fetus had resolution before birth with no postnatal recurrence, 2 had supressed VT prenatally that recurred after birth necessitating propranolol therapy as neonates, and 1 (cardiomyopathy case) never achieved full control. The 5th fetal case had rare episodes of VT and was not treated. Of the neonatal cases, 5 received intravenous anti-arrhythmics on admission: 4 amiodarone and 1 esmolol. Of these, 2 were converted to propranolol, 2 sotalol and the last was discharged on no medication. Three of the other 8 neonates initially received propranolol, 2 discharged on propranolol and the last discharge on mexiletine after failed propranolol and sotalol treatment. VT was suppressed or resolved with pharmacologic treatment in 3/4(75%) fetal cases and in 6/8 (75%) neonates at CONCLUSION The majority of fetal and neonatal VT is manageable with pharmacologic therapy. There may be a higher risk of demise in fetal versus neonatal VT. Given its rarity, a, multi-center studies are needed to identify optimal management strategies for this age group and further understand clinical outcomes.