Arrhythmias in Pregnancy

Kamala P. Tamirisa, Uri Elkayam, Joan E. Briller, Pamela K. Mason, Jayasree Pillarisetti, Faisal M. Merchant, Hena Patel, Dhanunjaya R. Lakkireddy, Andrea M. Russo, Annabelle Santos Volgman, Marmar Vaseghi

Research output: Contribution to journalReview articlepeer-review

Abstract

Increasing maternal mortality and incidence of arrhythmias in pregnancy have been noted over the past 2 decades in the United States. Pregnancy is associated with a greater risk of arrhythmias, and patients with a history of arrhythmias are at significant risk of arrhythmia recurrence during pregnancy. The incidence of atrial fibrillation in pregnancy is rising. This review discusses the management of tachyarrhythmias and bradyarrhythmias in pregnancy, including management of cardiac arrest. Management of fetal arrhythmias are also reviewed. For patients without structural heart disease, β-blocker therapy, especially propranolol and metoprolol, and antiarrhythmic drugs, such as flecainide and sotalol, can be safely used to treat tachyarrhythmias. As a last resort, catheter ablation with minimal fluoroscopy can be performed. Device implantation can be safely performed with minimal fluoroscopy and under echocardiographic or ultrasound guidance in patients with clear indications for devices during pregnancy. Because of rising maternal mortality in the United States, which is partly driven by increasing maternal age and comorbidities, a multidisciplinary and/or integrative approach to arrhythmia management from the prepartum to the postpartum period is needed.

Original languageEnglish (US)
Pages (from-to)120-135
Number of pages16
JournalJACC: Clinical Electrophysiology
Volume8
Issue number1
DOIs
StatePublished - Jan 2022

Keywords

  • arrhythmias
  • fetal
  • peripartum
  • pregnancy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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