Management of arrythmias during pregnancy

Introduction

A sensation of abnormal or irregular heart beating is a very common symptom in pregnancy. This is often secondary to sinus tachycardia, sinus bradycardia and sinus arrhythmia, or isolated premature atrial or ventricular arrhythmias (VAs). The overall incidence of arrhythmia documented in pregnancy is reported to be in the range of 0.03%–0.5% of pregnancies,1 making this one of the most common cardiac complications of pregnancy, in women with and without structural heart disease.2–4 The incidence of arrhythmia in pregnancy is increasing, a rise attributable to the increase in the proportion of women with structural heart disease achieving successful pregnancies in the last decade.5

Clinical evaluation of the symptomatic pregnant patient begins with a careful history, detailing the timing of onset of symptoms, frequency and potential exacerbating factors. A careful family history, probing for a history of unexplained sudden death, heart failure, cardiac transplant or pacemaker or defibrillator implantation may give clues to potentially high-risk inherited arrhythmia conditions. A personal history of syncope or presyncope in association with arrhythmia symptoms is also an important indication for more comprehensive evaluation.

The initial step in evaluation of gestational arrhythmia symptoms is to obtain a 12-lead ECG. Features such as ventricular pre-excitation in the form of a delta wave, pathological Q waves suggesting prior myocardial infarction, bundle branch block, hypertrophy, QTc prolongation or T wave inversion are important observations. These findings suggest underlying cardiac pathology and should prompt further evaluation. Ambulatory ECG monitoring …