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Arrhythmias during pregnancy

Summary

Atrial premature beats are frequently diagnosed during pregnancy (PR), supraventricular tachycardia (SVT; atrial tachycardia, AV nodal reentrant tachycardia, circus movement tachycardia) less frequently. For acute therapy, electrical cardioversion with 50-100 J is indicated in all unstable patients (pts). In stable SVT the initial therapy includes the vagal maneuver to terminate breakthrough tachycardias. For short-term management, when the vagal maneuver fails, intravenous adenosine is the first-choice drug and may safely terminate the arrhythmia. For long-term therapy, β-blocking agents with β1 selectivity are first-line drugs; Class Ic agents or the class III drug sotalol (sot) are effective and therapeutic alternatives. Ventricular premature beats are also frequently present during PR and benign in most pts; however, malignant ventricular tachyarrhythmias (sustained ventricular tachycardia [VT], ventricular flutter [VFlut], ventricular fibrillation [VF]) were observed less frequently. Electrical cardioversion is necessary in all pts with a hemodynamically unstable situation and life-threatening ventricular tachyarrhythmias; in hemodynamically stable pts, initial therapy with ajmaline, procainamide or lidocaine is indicated. If prophylactic therapy is needed, β-blocking agents with β1 selectivity are considered as first choice drugs. If this therapy is ineffective, class Ic agents or so can be considered. In pts with syncopal VT, VF, VFlut or aborted sudden death an implantable cardioverter-defibrillator is indicated. In pts with symptomatic bradycardia, a pacemaker can be implanted using echocardiography at any stage of PR. The treatment of the pregnant patient with cardiac arrhythmias requires important modification of the standard practice of arrhythmia management. The goal of therapy is to protect the patient and fetus through delivery, after which chronic or definitive therapy can be administered.

Summary

Supraventricular extrasystoles are often observed during pregnancy (SWS), but supraventricular tachycardias (atrial tachycardias, AV node reentry tachycardias, circus movement tachycardias) are less common. For acute therapy (AT) with hemodynamic instability (HI) an electrical cardioversion (KV) with 50-100 joules is necessary. If the hemodynamics (SH) are stable, vagal maneuvers should be performed primarily; if vagal measures fail, adenosine is the drug of choice. For long-term therapy (LZT), β is the most important1-selective beta blockers (BB) in question, less often specific antiarrhythmics (AA) of Class Ic or Class III (Sotalol [Sot]). Ventricular extrasystoles are also relatively common during a SWS and are harmless in most patients, while malignant ventricular arrhythmias (ventricular tachycardia KT, ventricular flutter KFlat, ventricular fibrillation KF) are rarely observed. An electrical KV should be used as AT for HI; for SH, ajmaline, procainamide or lidocaine can be considered. For the LZT primarily β1-selective BBs are used; in the case of therapy refractory, specific AAs of class Ic or Sot can be considered. The implantable defibrillator is a therapeutic alternative for Pt with syncopal KT, KF, KFlat or survived sudden death. In patients with symptomatic bradycardias, a pacemaker system can be implanted at any stage of the SWS under echo control. Despite the necessary peculiarities in therapeutic behavior during a SWS, all supraventricular and / or ventricular arrhythmias can be adequately treated, and with careful consideration of the risks, side effects and complications of all therapeutic measures, even complicated pregnancies can be successfully terminated.

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Affiliations

  1. Medical Clinic II, (focus on cardiology and angiology), Marienhospital University Clinic, Ruhr University Bochum, Hölkeskampring 40, 44625 Herne, Germany

    H.-J. Bustard & P. ​​Pfitzner

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Trappe, HJ., Pfitzner, P. Cardiac arrhythmias during pregnancy. Z cardiol90, IV36-IV44 (2001). https://doi.org/10.1007/s003920170026

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  • Key words Cardiac arrhythmias - pregnancy - sudden death - automatic implantable cardioverter defibrillator - antiarrhythmic drugs
  • Key words cardiac arrhythmias - pregnancy - sudden death - automatic defibrillator - antiarrhythmics