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Transplacental treatment of fetal tachycardia: A systematic review and meta-analysis. Prenat Diagn 2017 Nov;37(11):1076-1083

Date

08/24/2017

Pubmed ID

28833310

DOI

10.1002/pd.5144

Scopus ID

2-s2.0-85034627676 (requires institutional sign-in at Scopus site)   44 Citations

Abstract

OBJECTIVE: Multiple transplacental medications can be used to treat fetal tachycardia. We sought to perform a systematic review and meta-analysis to determine whether digoxin, flecainide, or sotalol was the most efficacious therapy for converting fetal tachycardia to sinus rhythm.

METHOD: We performed a systematic review and meta-analysis to compare digoxin, flecainide, or sotalol as first-line therapy for fetal tachycardia. Studies were identified by a search of PubMed (Medline), Web of Science, and Scopus.

RESULTS: There were 21 studies included. Flecainide (OR: 1.4, 95% CI: 1.1-2.0, I2  = 60%, P = 0.03) and sotalol (OR:1.4, 95% CI:1.1-2.0, I2  = 30%, P = 0.02) were superior to digoxin for conversion of fetal tachycardia to sinus rhythm. In those with hydrops, the benefit over digoxin was more notable for both flecainide (OR: 5.0, 95% CI: 2.5-10.0, I2  = 0%, P < 0.001) and sotalol (OR: 2.5, 95% CI: 1.7-5.0, I2  = 0%, P < 0.001). When limited to atrioventricular reentrant tachycardia, flecainide was superior to digoxin (OR:1.7, 95% CI:1.1-3.3, I2  = 62%, P = 0.03) and sotalol (OR:1.3, 95% CI:1.1-1.7, I2  = 0%, P = 0.01).

CONCLUSION: Digoxin should not be first-line therapy for fetal tachycardia, particularly in the presence of hydrops fetalis. Flecainide should be the first-line therapy of choice in atrioventricular reentrant tachycardia. Further study may identify further sub-populations responding differently.

Author List

Hill GD, Kovach JR, Saudek DE, Singh AK, Wehrheim K, Frommelt MA

Authors

Joshua Kovach MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
David Saudek MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Anoop K. Singh MD Associate Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Anti-Arrhythmia Agents
Digoxin
Female
Fetal Diseases
Fetal Therapies
Flecainide
Humans
Pregnancy
Sotalol
Tachycardia