The commonest arrhythmia in women of reproductive age, is
paroxysmal supraventricular tachycardia (SVT). We present a
rare case of SVT who presented for the first time during
pregnancy, who failed to respond to Electrical
cardioversion(ECV), but reverted back to sinus rhythm by
secondline pharmacotherapy.
PROCEDURE:
A 22 year old primigravidapresented at 37weeks in labour with
complaints of breathlessness and severe palpitations when she
was diagnosed to have supraventricular tachycardia(SVT) on
ECG and was referred to a tertiary care centre for further
management.Pharmacological cardioversion was attempted
with intravenous diltiazem, but in vain. Decision was taken for
electrical cardioversion with synchronized DC shocks of 50
joules and 100 joules successively, but was not successful too.
As a last resort, bolus of intravenous Amiodarone 150 mg was
given over 10 minutes followed by infusion at the rate of 24
mg per hour(2ml/hr), which finally brought down the heart
rate to 98bpm. In view of non-reassuring fetal heart rate
observed on CTG, patient was taken up for an emergency
caesarean section under epidural anaesthesia with grave risk
consent and shifted to ICCU post-operatively.
RESULT:
Patient delivered a male baby of birth weight 2.35kg. Patient
tolerated the surgery well and did not experience any episodes
of PSVT throughout the intra-operative period. Postoperatively
patient was managed in consultation with cardiologist.
Amiodarone infusion was continued for 24 hours at 24mg/
hour. Post-operative period was uneventful, patient was started
on oral anti arrhythmic medications and discharged on the
same.
CONCLUSION :
Accurate diagnosis, regular follow up and multidisciplinary
approach during acute episode and during delivery can prevent
life threatening risks that might be posed to the mother and
fetus in a case of PSVT. Treatment options include
nonpharmacological therapy, followed by adenosine and other
drugs if required, and lastly electrical cardioversion
Life-threatening paroxysmal supraventricular tachycardia developed during granulocyte transfusion therapy for neutropenia-related infection
