Meta-analysis and systematic review of amiodarone-inclusive treatment for fetal tachyarrhythmia

Objective: To analyze the efficacy of amiodarone-inclusive protocol and the safety of amiodarone in fetal tachyarrhythmia treatment. Methods: PubMed, Web of Science, Medline and Embase were searched. Randomized controlled trials, cohort studies, case series and case reports on the efficacy of amiodarone-based therapy and the amiodarone-related safety in fetal tachycardia were included. Case reports were presented separately and descriptively synthesized, while case series and cohort studies were included in the meta-analysis. Outcomes included conversion of the fetal rhythm and the occurrence of adverse effects induced by amiodarone in the fetus. This research was registered in PROSPERO (No.CRD42024560291). Results: We analyzed 107 pregnancies treated with amiodarone from 27 studies. A descriptive synthesis of 18 case reports yielded a cardioversion rate of 81.0% for amiodarone-inclusive protocol, which was further supported by a quantitative analysis of nine studies showing a pooled cardioversion rate of 69.9% (95% CI: 57.6%-81.2%). In the hydropic subgroup fetus, cardioversion rates ranged from 53.8% to 87.5% (median, 63.4%). Overall, adverse events were reported in 29 fetuses, with thyroid dysfunction being the most prevalent. The pooled incidence of thyroid dysfunction was 21.2% (95% CI:11.4%-32.6%). Conclusion: Amiodarone-inclusive protocol may be effective in fetal tachycardia management, particularly in refractory cases. These findings support amiodarone as an adjunctive therapy rather than monotherapy. Although its use was related to a risk of transient neonatal thyroid dysfunction, there was insufficient data to support an increase in the severe adverse reactions. Systematic Review Resgistration: PROSPERO (No. CRD42024560291).