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

Curr Med Res Opin. 2020 Jul;36(7):1225-1243. doi: 10.1080/03007995.2020.1762555. Epub 2020 May 18.

Abstract

Cardiac arrhythmias are the most common cardiac complication reported in pregnant women with and without structural heart disease (SHD); they are more frequent among women with SHD, such as cardiomyopathy and congenital heart disease (CHD). While older studies had indicated supraventricular tachycardia as the most common tachyarrhythmia in pregnancy, more recent data indicate an increase in the frequency of arrhythmias, with atrial fibrillation (AF) emerging as the most frequent arrhythmia in pregnancy, attributed to an increase in maternal age, cardiovascular risk factors and CHD in pregnancy. Importantly, the presence of any tachyarrhythmia during pregnancy may be associated with adverse maternal and fetal outcomes, including death. Thus, both the mother and the offspring need to be protected from such consequences. The use of antiarrhythmic drugs (AADs) depends on clinical presentation and on the presence of underlying SHD, which requires caution as it promotes pro-arrhythmia. In hemodynamically compromised women, electrical cardioversion is successful and safe to both mother and fetus. Use of beta-blockers appears quite safe; however, caution is advised when using other AADs, while no AAD should be used, if at all possible, during the first trimester when organogenesis takes place. Regarding the anticoagulation regimen in patients with AF, warfarin should be substituted with heparin during the first trimester, while direct oral anticoagulants are not indicated given the lack of data in pregnancy. Finally, for refractory arrhythmias, ablation and/or device implantation can be performed with current techniques in pregnant women, when needed, using minimal exposure to radiation. All these issues and relevant current guidelines are herein reviewed.

Keywords: Pregnancy; antiarrhythmic drugs; atrial fibrillation; cardiac arrest; cardiac arrhythmias; catheter ablation; implantable cardioverter defibrillator; supraventricular tachycardia; syncope; ventricular tachycardia.

Publication types

  • Review

MeSH terms

  • Anti-Arrhythmia Agents / therapeutic use
  • Anticoagulants / therapeutic use
  • Arrhythmias, Cardiac / therapy*
  • Electric Countershock
  • Female
  • Humans
  • Mothers
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / therapy*
  • Pregnant Women

Substances

  • Anti-Arrhythmia Agents
  • Anticoagulants