Our case presents a transplacental combined antiarrhythmic treatment lasting two months in a fetus with severe congenital heart defect. Fetal echocardiography revealed fetal supraventricular tachycardia and Ebstein anomaly. Digoxin monotherapy was not efficient alone, the combination with Verapamil was successful; the arrhythmia was converted to sinus rhythm after 15 days, the development of fetal hydrops and premature delivery were prevented. The importance of decision making of a multidisciplinary team and the very strict monitorization of both the mother and fetus is emphasized in order to avoid side effects of antiarrhythmic treatment After delivery a term baby was born, who underwent successful palliative cardiac surgery in the newbon period. The ECG showed Wolff-Parkinson-White syndrome, which did not require antiarrhythmic therapy after birth. A personalized transplacental pharmacologic treatment of a life-threatening arrhythmia could improve the outcome of even a very severe fetal cardiac disease.

Abbreviations: AIUM: American Institute of Ultrasound in Medicine; AV: Atrio-Ventricular; CTG: Cardiotocography; ECG: Electrocardiography; FHR: Fetal Heart Rate; GW: Gestational Week; CHD: Congenital Heart Defect; SVT: Supraventricular Tachycardia