Meta-analysis and systematic review of amiodarone-inclusive treatment for fetal tachyarrhythmia
- Journal
- Frontiers in pharmacology (Q1)
- Published
- 7 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Lingjun Kong, Yanan He, Xiang Li, Yuan Lu, Yahui Zhang
- PMID
- 42769344
- DOI
- 10.3389/fphar.2026.1912369
Why clinicians should know about it
- Picked for Pharmacology (medical) (paper of the day, 23 September 2026): Amiodarone fetal dosing, safety, PK considerations
Abstract
OBJECTIVE: To analyze the efficacy of amiodarone-inclusive protocol and the safety of amiodarone in fetal tachyarrhythmia treatment. METHODS: PubMed, Web of Science, Medline and Embase were searched. Randomized controlled trials, cohort studies, case series and case reports on the efficacy of amiodarone-based therapy and the amiodarone-related safety in fetal tachycardia were included. Case reports were presented separately and descriptively synthesized, while case series and cohort studies were included in the meta-analysis. Outcomes included conversion of the fetal rhythm and the occurrence of adverse effects induced by amiodarone in the fetus. This research was registered in PROSPERO (No.CRD42024560291). RESULTS: We analyzed 107 pregnancies treated with amiodarone from 27 studies. A descriptive synthesis of 18 case reports yielded a cardioversion rate of 81.0% for amiodarone-inclusive protocol, which was further supported by a quantitative analysis of nine studies showing a pooled cardioversion rate of 69.9% (95% CI: 57.6%-81.2%). In the hydropic subgroup fetus, cardioversion rates ranged from 53.8% to 87.5% (median, 63.4%). Overall, adverse events were reported in 29 fetuses, with thyroid dysfunction being the most prevalent. The pooled incidence of thyroid dysfunction was 21.2% (95% CI:11.4%-32.6%). CONCLUSION: Amiodarone-inclusive protocol may be effective in fetal tachycardia management, particularly in refractory cases. These findings support amiodarone as an adjunctive therapy rather than monotherapy. Although its use was related to a risk of transient neonatal thyroid dysfunction, there was insufficient data to support an increase in the severe adverse reactions. SYSTEMATIC REVIEW RESGISTRATION: PROSPERO (No. CRD42024560291).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.