Can COVID-19 Positivity in Mothers Cause Fetal and Neonatal Atrial Flutter?

Background Atrial flutter is an uncommon cause of fetal and neonatal tachyarrhythmias based on the mechanism of reentry. 1 , 2 If sustained for a prolonged period in a fetus, it may lead to congestive heart failure, nonimmune hydrops, and death. Clinical Description A 32-year-old mother presented with fetal atrial flutter (AFL) and hydrops at 33 weeks of gestation with a history of fever 2 weeks prior. She tested positive for COVID-19 and was advised to take medication for AFL; however, she was lost to follow-up. She reported back 4 weeks later. Repeat ultrasonography showed persistent atrial flutter with cardiomegaly and pericardial effusion. At birth, the neonate developed respiratory distress, and the electrocardiography showed atrial flutter. The neonate was managed with sotalol; flutter reverted to a normal rhythm after two doses. Subsequently, it led to QTc prolongation, which was normalized after stopping sotalol. On subsequent evaluation, the neonate had raised anti-SARS-CoV-2 antibody titers. Conclusions This case underscores the need for heightened awareness of potential arrhythmias in neonates, particularly in the context of maternal COVID-19 infection, and highlights the complexity of managing such cases with appropriate pharmacological and supportive interventions. The association between maternal COVID-19 and fetal arrhythmia remains an area of ongoing investigation, and this case may offer valuable insights into this emerging clinical concern.