DataSheet2_Efficacy and Safety of Various First-Line Therapeutic Strategies for Fetal Tachycardias: A Network Meta-Analysis and Systematic Review.PDF

Background: Fetal arrhythmias are common cardiac abnormalities associated with high mortality due to ventricular dysfunction and heart failure, particularly when accompanied by hydrops. Although several types of common fetal tachycardias have been relatively identified medications, such as digoxin, flecainide, and sotalol, there is no first-line drug treatment protocol established for the treatment of various types of fetal tachycardias.Methods: We conducted a network meta-analysis using a Bayesian hierarchical framework to obtain a model for integrating both direct and indirect evidence. All tachycardia types (Total group), supraventricular tachycardia (SVT subgroup), atrial flutter (AF subgroup), hydrops subgroup, and non-hydrops subgroup fetuses were analyzed, and five first-line regimens were ranked according to treatment outcomes: digoxin monotherapy (D), flecainide monotherapy (F), sotalol monotherapy (S), digoxin plus flecainide combination therapy (DF), and digoxin plus sotalol combination therapy (DS). Effectiveness and safety were determined according to the cardioversion rate and intrauterine death rate.Results: The pooled data indicated that DF combination therapy was always superior to D monotherapy, regardless of the tachycardia type or the presence of hydrops: Total, 2.44 (95% CrI: 1.59, 3.52); SVT, 2.77 (95% CrI: 1.59, 4.07); AF, 67.85 (95% CrI: 14.25, 168.68); hydrops, 6.03 (95% CrI: 2.54, 10.68); and non-hydrops, 5.06 (95% CrI: 1.87, 9.88). DF and F had a similar effect on control of fetal tachycardias. No significant differences were observed when comparing S, DS with D therapies across the subgroup analyses for the SVT, hydrops, and non-hydrops groups. No significant differences in mortality risks were among the various treatment regimens for the total group. And no significant differences were found in rates of intrauterine death rates at the same cardioversion amount.Conclusion The flecainide monotherapy and combination of digoxin and flecainide should be considered the most superior therapeutic strategies for fetal tachycardia.Systematic Review Registration: (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=288997), identifier (288997).

背景：胎儿心律失常是一种常见的与高死亡率相关的心脏异常，特别是当伴有水肿时，其死亡率更高。由于心室功能障碍和心力衰竭，尽管已相对识别出多种常见胎儿心动过速的类型，如地高辛、氟卡尼和索他洛尔等药物，但对于不同类型的胎儿心动过速的治疗，尚未建立一线药物治疗方案。方法：本研究采用贝叶斯分层框架进行网络荟萃分析，以获得整合直接和间接证据的模型。分析了所有心动过速类型（总组）、室上性心动过速（SVT亚组）、房颤（AF亚组）、水肿亚组和无水肿亚组的胎儿，并根据治疗结果对五种一线治疗方案进行了排序：地高辛单药治疗（D）、氟卡尼单药治疗（F）、索他洛尔单药治疗（S）、地高辛与氟卡尼联合治疗（DF）和地高辛与索他洛尔联合治疗（DS）。有效性及安全性根据转复率和宫内死亡率进行评估。结果：荟萃分析数据表明，无论心动过速类型或是否存在水肿，DF联合治疗始终优于D单药治疗：总组，2.44（95% CrI：1.59，3.52）；SVT亚组，2.77（95% CrI：1.59，4.07）；AF亚组，67.85（95% CrI：14.25，168.68）；水肿亚组，6.03（95% CrI：2.54，10.68）；无水肿亚组，5.06（95% CrI：1.87，9.88）。DF和F在控制胎儿心动过速方面具有相似的效果。在SVT、水肿和无水肿亚组的亚组分析中，S和DS与D治疗方案比较，未观察到显著差异。在总组中，各种治疗方案之间的死亡率风险无显著差异。并且，在相同的转复量下，宫内死亡率的比率也未发现显著差异。结论：氟卡尼单药治疗以及地高辛与氟卡尼的联合治疗应被认为是胎儿心动过速治疗的最优策略。系统评价注册：[https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=288997]，标识符（288997）。