Supraventricular arrhythmia in pregnancy

Abstract

The physiological changes during pregnancy predispose a woman for the development of new-onset or recurrent arrhythmia. Supraventricular arrhythmia is the most common form of arrhythmia during pregnancy and, although often benign in nature, can be concerning. We describe three complex cases of supraventricular arrhythmia during pregnancy and review the currently available literature on the subject. In pregnancies complicated by arrhythmia, a plan for follow-up and both maternal and fetal monitoring during pregnancy, delivery and post partum should be made in a multidisciplinary team. Diagnostic modalities should be used as in non-pregnant women if there is an indication. All antiarrhythmic drugs cross the placenta, but when necessary, medical treatment should be used with consideration to the fetus and the mother’s altered pharmacodynamics and kinetics. Electrical cardioversion is safe during pregnancy, and electrophysiological study and catheter ablation can be performed in selected patients, preferably with zero-fluoroscopy technique. Sometimes, delivering the fetus (if viable) is the best therapeutic option. In this review, we provide a framework for the workup and clinical management of supraventricular arrhythmias in pregnant women, including cardiac, obstetric and neonatal perspectives.

Postpartum maternal tachycardia – diagnostic pitfalls!

“…Other haemodynamic changes in pregnancy are shown in Table 1. During labour there are further neurohormonal changes and pain responses, which stimulate the sympathetic nervous system and increase the maternal heart rate even more [4 ▪ ].…”

Sex and racial disparities in catheter ablation

“… 18 AF occurs is 0.03–0.06 of pregnancies, whereas reported rates for other SVTs are between 0.02% and 0.5% of pregnancies. 18 , 19 For about half of these women this is the first presentation, whereas women with known AF or SVT are likely to experience worsening of their symptoms and an increased number of episodes because of the altered volume status and increased sympathetic activity. 19 , 20 The management of SVTs during pregnancy is limited to electrical cardioversion and/or pharmacologic management; however, the choice of antiarrhythmic drug should be well considered.…”

“… 18 , 19 For about half of these women this is the first presentation, whereas women with known AF or SVT are likely to experience worsening of their symptoms and an increased number of episodes because of the altered volume status and increased sympathetic activity. 19 , 20 The management of SVTs during pregnancy is limited to electrical cardioversion and/or pharmacologic management; however, the choice of antiarrhythmic drug should be well considered. 18 , 19 Fluoroless catheter ablation during pregnancy has been performed successfully but requires further research, as data currently are limited.…”

“… 19 , 20 The management of SVTs during pregnancy is limited to electrical cardioversion and/or pharmacologic management; however, the choice of antiarrhythmic drug should be well considered. 18 , 19 Fluoroless catheter ablation during pregnancy has been performed successfully but requires further research, as data currently are limited. 21 …”

Direct current cardioversion in pregnancy: a multicentre study

“…In many normal pregnancies, women experience palpitations, which following investigation are benign non‐sustained atrial or ventricular ectopic beats that do not require treatment 2–4 . However, some arrhythmias require cardiac medication and, if acute, refractory and/or compromising maternal circulation, require direct current cardioversion (DCCV) to restore sinus rhythm 5–8 . The Resuscitation Council algorithm for management of acute tachycardia should be followed 9 and DCCV undertaken promptly when indicated to maintain cardiovascular output and prevent maternal compromise.…”