DataSheet1_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，这种死亡率主要由于心室功能障碍和心力衰竭引起，尤其是在伴有水肿的情况下。尽管已经相对确定了多种常见胎儿心动过速的药物治疗方法，如地高辛、氟卡尼和索他洛尔，但对于各种类型胎儿心动过速的治疗，尚未建立一线药物治疗的规范。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（总体组）、室上性心动过速（SVT亚组）、房扑（AF亚组）、水肿亚组和非水肿亚组的胎儿，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）、地高辛加氟卡尼联合治疗（DF）和地高辛加索他洛尔联合治疗（DS）。有效性及安全性根据电复律率和宫内死亡率的指标进行判定。结果：汇总数据显示，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：总体组，2.44（95% CrI：1.59，3.52）；SVT组，2.77（95% CrI：1.59，4.07）；AF组，67.85（95% CrI：14.25，168.68）；水肿组，6.03（95% CrI：2.54，10.68）；非水肿组，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、水肿和非水肿亚组的亚组分析中，与D治疗方案相比，S和DS未观察到显著差异。在总体组中，各种治疗方案之间的死亡率风险无显著差异。在相同的电复律量下，宫内死亡率的比率亦未发现显著差异。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视为治疗胎儿心动过速的最优治疗方案。系统评价注册：[https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=288997]，识别码（288997）。