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First‐Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta‐Analysis

BACKGROUND: There is no consensus on the most effective and best tolerated first‐line antiarrhythmic treatment for fetal tachyarrhythmia. The purpose of this systematic review and meta‐analysis was to compare the efficacy, safety, and fetal–maternal tolerance of first‐line monotherapies for fetal su...

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Autores principales: Alsaied, Tarek, Baskar, Shankar, Fares, Munes, Alahdab, Fares, Czosek, Richard J, Murad, Mohammad Hassan, Prokop, Larry J, Divanovic, Allison A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779032/
https://www.ncbi.nlm.nih.gov/pubmed/29246961
http://dx.doi.org/10.1161/JAHA.117.007164
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author Alsaied, Tarek
Baskar, Shankar
Fares, Munes
Alahdab, Fares
Czosek, Richard J
Murad, Mohammad Hassan
Prokop, Larry J
Divanovic, Allison A
author_facet Alsaied, Tarek
Baskar, Shankar
Fares, Munes
Alahdab, Fares
Czosek, Richard J
Murad, Mohammad Hassan
Prokop, Larry J
Divanovic, Allison A
author_sort Alsaied, Tarek
collection PubMed
description BACKGROUND: There is no consensus on the most effective and best tolerated first‐line antiarrhythmic treatment for fetal tachyarrhythmia. The purpose of this systematic review and meta‐analysis was to compare the efficacy, safety, and fetal–maternal tolerance of first‐line monotherapies for fetal supraventricular tachycardia and atrial flutter. METHODS AND RESULTS: A comprehensive search of several databases was conducted through January 2017. Only studies that made a direct comparison between first‐line treatments of fetal tachyarrhythmia were included. Outcomes of interest were termination of fetal tachyarrhythmia, fetal demise, and maternal complications. Ten studies met inclusion criteria, with 537 patients. Overall, 291 patients were treated with digoxin, 137 with flecainide, 102 with sotalol, and 7 with amiodarone. Digoxin achieved a lower rate of supraventricular tachycardia termination compared with flecainide (odds ratio [OR]: 0.773; 95% confidence interval [CI], 0.605–0.987; I(2)=34%). In fetuses with hydrops fetalis, digoxin had lower rates of tachycardia termination compared with flecainide (OR: 0.412; 95% CI, 0.268–0.632; I(2)=0%). There was no significant difference in the incidence of maternal side effects between digoxin and flecainide groups (OR: 1.134; 95% CI, 0.129–9.935; I(2)=80.79%). The incidence of maternal side effects was higher in patients treated with digoxin compared with sotalol (OR: 3.148; 95% CI, 1.468–6.751; I(2)=0%). There was no difference in fetal demise between flecainide and digoxin (OR: 0.767; 95% CI, 0.140–4.197; I(2)=44%). CONCLUSIONS: Flecainide may be more effective treatment than digoxin as a first‐line treatment for fetal supraventricular tachycardia.
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spelling pubmed-57790322018-01-26 First‐Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta‐Analysis Alsaied, Tarek Baskar, Shankar Fares, Munes Alahdab, Fares Czosek, Richard J Murad, Mohammad Hassan Prokop, Larry J Divanovic, Allison A J Am Heart Assoc Systematic Review and Meta‐Analysis BACKGROUND: There is no consensus on the most effective and best tolerated first‐line antiarrhythmic treatment for fetal tachyarrhythmia. The purpose of this systematic review and meta‐analysis was to compare the efficacy, safety, and fetal–maternal tolerance of first‐line monotherapies for fetal supraventricular tachycardia and atrial flutter. METHODS AND RESULTS: A comprehensive search of several databases was conducted through January 2017. Only studies that made a direct comparison between first‐line treatments of fetal tachyarrhythmia were included. Outcomes of interest were termination of fetal tachyarrhythmia, fetal demise, and maternal complications. Ten studies met inclusion criteria, with 537 patients. Overall, 291 patients were treated with digoxin, 137 with flecainide, 102 with sotalol, and 7 with amiodarone. Digoxin achieved a lower rate of supraventricular tachycardia termination compared with flecainide (odds ratio [OR]: 0.773; 95% confidence interval [CI], 0.605–0.987; I(2)=34%). In fetuses with hydrops fetalis, digoxin had lower rates of tachycardia termination compared with flecainide (OR: 0.412; 95% CI, 0.268–0.632; I(2)=0%). There was no significant difference in the incidence of maternal side effects between digoxin and flecainide groups (OR: 1.134; 95% CI, 0.129–9.935; I(2)=80.79%). The incidence of maternal side effects was higher in patients treated with digoxin compared with sotalol (OR: 3.148; 95% CI, 1.468–6.751; I(2)=0%). There was no difference in fetal demise between flecainide and digoxin (OR: 0.767; 95% CI, 0.140–4.197; I(2)=44%). CONCLUSIONS: Flecainide may be more effective treatment than digoxin as a first‐line treatment for fetal supraventricular tachycardia. John Wiley and Sons Inc. 2017-12-15 /pmc/articles/PMC5779032/ /pubmed/29246961 http://dx.doi.org/10.1161/JAHA.117.007164 Text en © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Systematic Review and Meta‐Analysis
Alsaied, Tarek
Baskar, Shankar
Fares, Munes
Alahdab, Fares
Czosek, Richard J
Murad, Mohammad Hassan
Prokop, Larry J
Divanovic, Allison A
First‐Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta‐Analysis
title First‐Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta‐Analysis
title_full First‐Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta‐Analysis
title_fullStr First‐Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta‐Analysis
title_full_unstemmed First‐Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta‐Analysis
title_short First‐Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta‐Analysis
title_sort first‐line antiarrhythmic transplacental treatment for fetal tachyarrhythmia: a systematic review and meta‐analysis
topic Systematic Review and Meta‐Analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779032/
https://www.ncbi.nlm.nih.gov/pubmed/29246961
http://dx.doi.org/10.1161/JAHA.117.007164
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