Cardiac arrhythmias in pregnant women: need for mother and offspring protection

Purpose. Pregnant women, due to physiological changes in the body, are more prone to cardiac arrhythmias, the frequency of which ranges from 5 to 18%. Paroxysmal supraventricular tachycardia (SVT) occurs in 14% of pregnant women with cardiac arrhythmias. In the treatment of cardiac arrhythmias, radiofrequency ablation (RFA) is currently preferred over antiarrhythmic drugs. However, RFA is associated with radiation exposure to the mother and fetus. The current level of development of arrhythmology provides a unique opportunity to eliminate cardiac arrhythmias without the use of fluoroscopic technologies, which completely excludes radiation exposure.Clinical case. The article presents a clinical case of a 17-year-old patient diagnosed with idiopathic paroxysmal atrial tachycardia successfully treated in Cardiology Research Institute, Tomsk NRMC. When admitted to the hospital, the patient was at 31 weeks of pregnancy.Conclusion. The described case shows the possibility and necessity of using non-fluoroscopic navigation systems when performing RFA in pregnant women. RFA using electroanatomic mapping allows to remove the burden of receiving antiarrhythmic therapy in pregnant women without the use of X-ray.

Download Full-text

CARDIAC ARRHYTHMIAS DURING PREGNANCY: A CLINICAL APPROACH

Fetal and Maternal Medicine Review ◽

10.1017/s0965539511000076 ◽

2011 ◽

Vol 22 (2) ◽

pp. 123-143 ◽

Cited By ~ 7

Author(s):

ZACHARY LAKSMAN ◽

LOUISE HARRIS ◽

CANDICE K SILVERSIDES

Keyword(s):

Heart Disease ◽

Pregnant Women ◽

Cardiac Disease ◽

Cardiac Arrhythmias ◽

De Novo ◽

Structural Heart Disease ◽

Clinical Approach ◽

History Of ◽

In Pregnancy

Physiologic changes in maternal haemodynamics, hormones and autonomic properties contribute to arrhythmias in pregnancy. While arrhythmias most commonly occur in pregnant women with structural heart disease or those with a history of cardiac arrhythmias, they can also occur de novo in women with no documented cardiac disease.

Download Full-text

Treatment for cardiac arrhythmias in pregnancy: Efficiency and safety

Cardiosomatics ◽

10.26442/cs45058 ◽

2013 ◽

Vol 4 (2) ◽

pp. 81-91

Author(s):

Yu. A Bunin

Keyword(s):

Pregnant Women ◽

Cardiac Arrhythmias ◽

Ventricular Arrhythmias ◽

Wide Spectrum ◽

Antiarrhythmic Agents ◽

Potentially Malignant ◽

Fetal Safety ◽

Surgical Treatments ◽

Practical Recommendations ◽

New Onset

Pregnancy with its physiological neurohumoral and hemodynamic changes may cause new-onset cardiac arrhythmia or worsen existing arrhythmias. It is important to single out the arrhythmias in pregnant women, which pose no risk for mother or fetus and therefore are not a contraindication to vaginal delivery and occasionally need no medical treatment. On the other hand, the arrhythmias, that impair hemodynamics and those that are referred to as the so-called potentially malignant and malignant cardiac arrhythmias, require specific pharmacotherapy and, in a number of cases, invasive treatments. Arrhythmias pharmacotherapeutic challenges in pregnant women are determined by that many antiarrhythmic agents may be harmful to the fetus and that the results of controlled trials of this problem are few and conflicting. The paper covers the current areas and some disputable issues of medical and surgical treatments for a wide spectrum of supraventricular and ventricular arrhythmias in pregnant women and gives practical recommendations for the use of different classes of antiarrhythmic agents in them to stop and prevent cardiac arrhythmias depending on their fetal safety and the pattern of maternal cardiovascular and concomitant diseases.

Download Full-text

Management and perinatal outcomes of cardiac arrhythmias in pregnancy

EP Europace ◽

10.1093/europace/euab116.049 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

A Abdrakhmanov ◽

B Ainabekova ◽

O Nuralinov ◽

A Bakytzhanuly ◽

A Smagulova

Keyword(s):

Drug Therapy ◽

Pregnant Women ◽

Supraventricular Tachycardia ◽

Cardiac Arrhythmias ◽

Perinatal Outcomes ◽

Adverse Outcomes ◽

Fetal Mortality ◽

Haemodynamic Instability ◽

Invasive Treatment ◽

In Pregnancy

Abstract Funding Acknowledgements Type of funding sources: None. Background Arrhythmias in pregnancy are common and can cause significant complications. The decision to use drug therapy or invasive treatment in pregnancy must have absolutely reasons. Data on perinatal outcomes in pregnant women with arrhythmias is limited. Objective The aim of our study is to observe the characteristics and prognosis of cardiac arrhythmias in pregnant women. Methods 72 pregnant women with arrhythmias have been included (single-center, prospectively study). Mean age of patients: 28,34 ± 5,25years, mean gestation age 22,37 ± 6,77 weeks. Clinical characteristics of patients, obstetric and neonatal outcomes were documented. Results The most common reported arrhythmias were supraventricular tachycardia (n = 32; 44%). This was followed by premature contractions (n = 29; 40%). Advanced heart block (n = 7; 10%) and ventricular tachycardia (n = 4; 6%) were exceedingly rare during pregnancy. Arrhythmias was benign in 12 patients (17%) and did not require drug therapy. Administration of antiarrhythmic treatment was justified when symptoms were very frequent and cause haemodynamic instability (n = 52; 65,7%). In patients with drug refractory and dangerous rhythm disturbances (n = 22; 31%) were performed catheter ablation by using 3D navigation system without fluoroscopy. Permanent pacemaker was implanted in 7 cases (10%) of third-degree atrioventricular block. Interventions were effective in all cases without adverse outcome. In the majority of cases were spontaneus vaginal (n = 48; 66,7%) or vaginal-assisted (n = 6; 8,3%) delivery. Eighteen pregnancies (25%) were delivered by cesarean section. Intrapartum hemorrhage was 350,4 ± 238,2 ml. Maternal cardiac events and obstetric complications were none declared. There were 72 live births (in all pregnancies). Fetal birth weight was 3407,39 ± 785,61 grams, 5 minute Apgar was 8,47 ± 1,6. There were no maternal and fetal mortality. Conclusions supraventricular tachycardia and premature beats are common in pregnancy. Spontaneous vaginal delivery is more likely in this patients. Major maternal and fetal adverse outcomes are infrequent in pregnant women with arrhythmias.

Download Full-text

P5361Pregnancy in patients with cardiac arrhythmias

European Heart Journal ◽

10.1093/eurheartj/ehz746.0326 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Kirgizova ◽

A Dedkova ◽

I Kisteneva ◽

E Borisova

Keyword(s):

Pregnant Women ◽

Cardiac Arrhythmias ◽

Radiation Risk ◽

Pacemaker Implantation ◽

Preterm Births ◽

Block Type ◽

Type Ii ◽

Av Block ◽

Female Population ◽

Premature Beats

Abstract Introduction Negative trends in the state of somatic and reproductive health of the female population are observed in the last decades all over the world. On the background of declining birth rates, the problems of managing pregnancy in women with extragenital pathology become relevant. Aim To study the effects of cardiac arrhythmias and antiarrhythmic treatment on the course and outcomes of pregnancy. Material and methods A total of 55 case histories of pregnant women hospitalized in the Department of Interventional Arrhythmology. All patients signed informed consent to be enrolled in the study. The age of patients ranged from 17 to 41 years (mean age of 30.2±4.0 years). Patients were hospitalized on average at 28.0±6.4 weeks of gestation (from 12 to 37 weeks) and had some form of cardiac arrhythmia. Results Cardiac arrhythmias were idiopathic in 65% of cases; the rest of patients had verified cardiovascular diseases. Cardiac arrhythmias were registered in 41 (74%) of women prior to pregnancy and their arrhythmological history lasted for 7.9±1.1 years. Extrasystolic arrhythmia was the most common type of cardiac arrhythmias: ventricular premature beats occurred in 23 pregnant women (42%) including supraventricular premature beats in 8 patients (14%), supraventricular tachycardia in 12 patients (22%), and ventricular tachycardia (VT) in 5 women (9%). In three cases, VTs were hemodynamically significant. Radiofrequency ablation (RFA) of VT was performed in pregnant women at 26, 27, and 32 weeks of gestation. Five patients with gestational ages of 27–34 weeks received RFA for atrial tachycardia and atrioventricular (AV) reciprocal tachycardia to treat symptomatic intracardiac tachycardia (n=4) and continuous recurrent AV nodal tachycardia (n=1), paroxysms of which were accompanied by destabilization of hemodynamics. AV block was registered in 4 pregnant women (9%); sick sinus syndrome was diagnosed in 1 patient (2%). Implantation of pacemaker was required in 1 case for a second-degree AV block type II (Mobitz type II) at 24 weeks of pregnancy. RFA and pacemaker implantation were carried out with minimal or zero fluoroscopy and only after the 22nd week of pregnancy, that is, without or with reduced radiation risk to the fetus. 16 patients (29%) had cesarean section; the rest of patients had spontaneous vaginal delivery. The average Apgar scores were 8.64 immediately after birth and 9.35 five minutes after birth. Preterm births (n=2) were due to obstetric pathology and were not associated with cardiac arrhythmias. Cardiac arrhythmias were not observed in any patient in childbirth. Conclusions Cardiac arrhythmias, observed in patients, did not require termination of pregnancy. Catheter ablation for symptomatic, hemodynamically significant, and life-threatening cardiac arrhythmias made it possible to effectively guide pregnant women to delivery with a close follow-up.

Download Full-text