Elsevier

Seminars in Perinatology

Volume 38, Issue 5, August 2014, Pages 285-288
Seminars in Perinatology

Cardiac arrhythmias in pregnancy

https://doi.org/10.1053/j.semperi.2014.04.017Get rights and content

Abstract

As more women with repaired congenital heart disease survive to their reproductive years and many other women are delaying pregnancy until later in life, a rising concern is the risk of cardiac arrhythmias during pregnancy. Naturally occurring cardiovascular changes during pregnancy increase the likelihood that a recurrence of a previously experienced cardiac arrhythmia or a de novo arrhythmia will occur. Arrhythmias should be thoroughly investigated to determine if there is a reversible etiology, and risks/benefits of treatment options should be fully explored. We discuss the approach to working up and treating various arrhythmias during pregnancy with attention to fetal and maternal risks as well as treatment of fetal arrhythmias. Acute management in stable patients includes close monitoring and intravenous pharmacologic therapy, while DC cardioversion should be used to terminate arrhythmias in hemodynamically unstable patients. Long-term management may require continued oral antiarrhythmic therapy, with particular attention to fetal safety, to prevent complications associated with arrhythmias.

Section snippets

Fetal arrhythmias

Fetal arrhythmias are usually diagnosed echocardiographically by assessment of the chronological relationship between the atrial and ventricular contractions.24 Fetal magnetocardiography may further clarify the mechanism underlying the arrhythmia.25 Tachyarrhythmia is diagnosed when the fetal heart rate exceeds 180 per min.26 SVTs include AV nodal reentry, AV reentry (due to an accessory pathway) EAT, or permanent junctional reciprocating tachycardia, and assessment of the RP and PR intervals

Summary

Cardiac arrhythmias during pregnancy are being seen with increasing frequency as women with congenital heart disease are surviving into their reproductive years and older women with acquired heart disease are pursuing pregnancy. Prompt evaluation and treatment can make a difference to the well-being of both the mother and the fetus.

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