Successful Direct Current Cardioversion (DCCV) in Pregnancy in a Non-Obstetric Emergency Department

Abstract

Atrial Fibrillation (AF) is uncommon in pregnancy but associated with significant mortality. Although controlled studies evaluating therapeutic management of AF in pregnancy are lacking, current guidelines suggest that direct current cardioversion (DCCV) is safe in cases of maternal arrhythmia with hemodynamic compromise. In this report, we discuss a female patient of 22 weeks gestation who presented to the non-obstetric Emergency Department (ED) with acute onset, symptomatic AF. Following consultation with emergency medicine, cardiology, and maternal-fetal medicine specialists, rhythm control was favored for immediate management. A single 200 joules synchronized shock resulted in a successful reversion to sinus rhythm with no adverse events using agreed procedural sedation protocols. The patient had an uneventful inpatient course and was later discharged with outpatient cardiology and obstetric follow-up. This case contributes to the evidence that DCCV is safe in pregnant patients and proposes that standard medications used for analgesia and sedation in cardioversion are safe in pregnancy. A multidisciplinary team approach is key in managing AF in pregnancy in the acute non-obstetric setting.