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

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.

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.

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).

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.