Transplacental treatment of fetal tachycardia: A systematic review and meta‐analysis

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, I 2 = 60%, P = 0.03) and sotalol (OR:1.4, 95% CI:1.1–2.0, I 2 = 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, I 2 = 0%, P < 0.001) and sotalol (OR: 2.5, 95% CI: 1.7–5.0, I 2 = 0%, P < 0.001). When limited to atrioventricular reentrant tachycardia, flecainide was superior to digoxin (OR:1.7, 95% CI:1.1–3.3, I 2 = 62%, P = 0.03) and sotalol (OR:1.3, 95% CI:1.1–1.7, I 2 = 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.