{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T13:36:59Z","timestamp":1792157819395,"version":"4.4.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,12,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">There is no consensus on the most effective and best tolerated first\u2010line antiarrhythmic treatment for fetal tachyarrhythmia. The purpose of this systematic review and meta\u2010analysis was to compare the efficacy, safety, and fetal\u2013maternal tolerance of first\u2010line monotherapies for fetal supraventricular tachycardia and atrial flutter.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A comprehensive search of several databases was conducted through January 2017. Only studies that made a direct comparison between first\u2010line 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 [\n              <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n              ]: 0.773; 95% confidence interval [\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              ], 0.605\u20130.987; I\n              <jats:sup>2<\/jats:sup>\n              =34%). In fetuses with hydrops fetalis, digoxin had lower rates of tachycardia termination compared with flecainide (\n              <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n              : 0.412; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 0.268\u20130.632; I\n              <jats:sup>2<\/jats:sup>\n              =0%). There was no significant difference in the incidence of maternal side effects between digoxin and flecainide groups (\n              <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n              : 1.134; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 0.129\u20139.935; I\n              <jats:sup>2<\/jats:sup>\n              =80.79%). The incidence of maternal side effects was higher in patients treated with digoxin compared with sotalol (\n              <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n              : 3.148; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 1.468\u20136.751; I\n              <jats:sup>2<\/jats:sup>\n              =0%). There was no difference in fetal demise between flecainide and digoxin (\n              <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n              : 0.767; 95%\n              <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n              , 0.140\u20134.197; I\n              <jats:sup>2<\/jats:sup>\n              =44%).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Flecainide may be more effective treatment than digoxin as a first\u2010line treatment for fetal supraventricular tachycardia.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.117.007164","type":"journal-article","created":{"date-parts":[[2017,12,16]],"date-time":"2017-12-16T01:11:27Z","timestamp":1513386687000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":83,"title":["First\u2010Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1161","volume":"6","author":[{"given":"Tarek","family":"Alsaied","sequence":"first","affiliation":[{"name":"The Heart Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH"},{"name":"Department of Cardiology, Boston Children's Hospital, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shankar","family":"Baskar","sequence":"additional","affiliation":[{"name":"The Heart Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munes","family":"Fares","sequence":"additional","affiliation":[{"name":"The Congenital heart collaborative Rainbow Babies and Children's Hospital, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fares","family":"Alahdab","sequence":"additional","affiliation":[{"name":"Mayo Clinic Evidence\u2010based Practice Center Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J","family":"Czosek","sequence":"additional","affiliation":[{"name":"The Heart Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Hassan","family":"Murad","sequence":"additional","affiliation":[{"name":"Mayo Clinic Evidence\u2010based Practice Center Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry J","family":"Prokop","sequence":"additional","affiliation":[{"name":"Mayo Clinic Libraries Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison A","family":"Divanovic","sequence":"additional","affiliation":[{"name":"The Heart Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006254-197908000-00001"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-003-0589-x"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2015.11.007"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2016.03.023"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/heart.89.8.913"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)90122-8"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(80)90441-9"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2010.11.001"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.026120"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-002-0337-7"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1970151309"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000437597.44550.5d"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"e_1_3_3_15_2","first-page":"187","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins JPT","year":"2011","unstructured":"Higgins JPT. 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