Arrhythmias in pregnancy (RCD code: VII‑V)

Sylwia Wiśniowska‑Śmiałek, Agata Leśniak‑Sobelga, Magdalena Kostkiewicz, Piotr Podolec

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Abstract


Cardiovascular diseases in pregnancy are the most common causes of maternal mortality in developed world and an important cause of heart failure, stroke, and arrhythmia. Cardiac disease complicates 0.4–4% of all pregnancies, and arrhythmias are among the most common cardiac complications [1]. In some cases, pregnancy triggers exacerbations of pre-existing arrhythmias, whereas in others it may manifest for the first time [2]. A prior history of arrhythmias or structural heart disease and family history of sudden death are the factors that matter to risk of tachyarrhythmias during pregnancy [3]. Due to extraordinary ethical considerations in pregnant women, there are only a few randomized studies and little data on efficacy or safety of antiarrhythmic drugs applied during pregnancy [4]. Therefore, much of clinical care is guided by general knowledge about hemodynamic changes in pregnant women, universal principles of treatment of arrhythmias and finally by gained experience in that area. Multi-disciplinary approach remains the overriding principle in management of pregnant woman with arrhythmias, including collaboration with gynecological and obstetric center. JRCD 2016; 2 (6): 177–180

 


Keywords


electrocardiography, antiarrhythmic drugs, catheter ablation; pacemaker; implantable cardioverter‑defibrillator; rare disease

References


Siu SC, Sermer M, Colman JM, et al. Cardiac Disease in Pregnancy (CARPREG) Investigators. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation, 2001; 104: 515–521.

Lee SH, Chen SA, Wu TJ, et al. Effect of pregnancy on first onset and symptoms of paroxysmal supraventricular tachycardia. Am J Cardiol, 1995; 76: 675–678.

Laksman Z, Harris l, Silversides CK. Cardiac arrhythmias during pregnancy: a clinical approach. Fetal Matern Med Rev. 2011; 22: 123–143.

Enriquez AD, Economy KE, Tedrow UB. Contemporary management of arrhythmias during pregnancy. Circ Arrhythm Electrophysiol. 2014;7:961–7

Ninio DM, Saint DA. The role of stretch-activated channels in atrial fibrillation and the impact of intracellular acidosis. Prog Biophys Mol Biol, 2008; 97: 401–416.

Franz MR, Cima R, Wang D. Electrophysiological effects of myocardial stretch and mechanical determinants of stretch-activated arrhythmias. Circulation, 1992; 86: 968–978.

Odening KE, Choi BR, Liu GX, et al. Estradiol promotes sudden cardiac death in transgenic long QT type 2 rabbits while progesterone is protective. Heart Rhythm, 2012; 9: 823–832.

Albert CM, Andreotti F, Badimon L, et al. Female sex as an independent risk factor for stroke in atrial fibrillation: possible mechanisms. Thromb Haemost, 2014; 111: 385–391.

Roberts JM, Insel PA, Goldfien. Regulation of myometrial adrenoreceptors and adrenergic response by sex steroids, Mol Pharmacol, 1981; 20: 52–58.

Barron WM, Mujais SK, Zinaman M, et al. Plasma catecholamine response to pchysiologic stimuli in normal human pregnancy. Am J Obstet Gynecol, 1986; 154: 80–84. 11. Stewart Hunter, Stephen C Robson. Adaptation of the maternal heart in pregnancy. Br Heart J, 1992; 68: 540–543

Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 3147–3197

Adamson DL, Nelson-Piercy C. Managing palpitations and arrhythmias during pregnancy. Heart 2007; 93: 1630–1636.

Joglar JA, Page RL. Treatment of cardiac arrhythmias during pregnancy: safety considerations. Drug Saf.1999; 20: 85–94.

Schotan A, Ostrzega E, Mehra A, et al. Incidence of arrhythmias in normal pregnancy and relation to palpitations, dizziness and syncope, Am J Cardiol 1997; 79: 1061–1064.

Li JM, Nguyen C, Joglar JA, et al. Frequency outcome of arrhythmias complicating admission during pregnancy: experience from a high-volume and ethnically diverse obstetric service. Clin cardiol 2008; 31: 358–541.

Pelg D, Orvieto R, Ferber A. Maternal supraventricular tachycardia recorded as apparent fetal heart rate in a case of fetal demise. Acta Obstet Gynecol Scand1998; 77: 786–787.

Smith WM, Gallagher JJ, Kerr CR, et al. The electrophysiologic basis and management of symptomatic recurrent tachycardia in patients with Ebstein’s anomaly of the tricuspid valve. Am J Cardiol 1982; 49: 1223–1234.

Elkayam U, Goodwin TM. Adenosine therapy for supraventricular tachycardia during pregnancy, Am J Cardiol, 1995;75:521–523

Blomström-Lundqvist C, Scheinman MM, Aliot EM, et al. European Society of Cardiology Committee, NASPE-Heart Rhythm Society. European Society of Cardiology Committee for Practice Guidelines, Writting Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias-executive summary. J Am Coll Cardiol 2003; 42: 1493–1531.

Cox JL, Gardner MJ. Treatment of cardiac arrhythmias during pregnancy. Prog Cardiovasc Disease 1993; 36: 137–178.

Bongiorni MG, Di Cori A, Soldati E, et al. Radiofrequency catheter ablation of atrioventricular nodal reciprocating tachycardia using intracardiac echocardiography in pregnancy, Europace 2008; 10: 1018–1021.

Jastrzębski M, Rajtar-Salwa R, Czarnecka D. Ablation of incessant supraventricular tachycardia in pregnancy. JRCD 2013; 1 (4): 158–162.

Doig JC, Mc Comb JM, Reid DS, et al. Incessant atrial tachycardia accelerated by pregnancy. Br Heart J 1992; 67: 266–268.

Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 2010; 12: 1360–1420.

Burkat TA, Kron J, Miles WM, et al. Successful termination of atrial Flutter by ibutilide during pregnancy. Pacing Clin Electrophysiol 2007; 30: 283–286.

Kockova R, Kocka V, Kiernan T, et al. Ibutilide-induced cardioversion of atrial fibrillation during pregnancy. J Cardiovasc Electrophysiol. 2007; 18: 545–547.

Silversides CK, Harris L, Haberer K, et al. Recurrence rates of arrhythmias during pregnancy in women with previous tachyarrhythmia and impact on fetal and neonatal outcomes. Am J Cardiol 2006; 97: 1206–1212.

Autore C, Conte MR, Piccininno M, et al. Risk associated with pregnancy in hypertrophic cardiomyopathy. J Am Coll Cardiol 2002; 40: 1864–1869

Bauce B, Dalliento L, Frigo G, et al. Pregnancy in women with arrhythmogenic right ventricular cardiomyopathy/dysplasia. Eur J Obstet Gynecol Reprod Biol 2006; 127: 186- 189.

Tateno S, Nitwa K, Nakazawa M, et al. Study Group for Arrhythmia Late after Surgery for Congenital Heart Disease (ALTAS-CHD). Arrhythmia and conduction disturbances in patients with congenital heart disease during pregnancy: multicenter study. Circ J 2003; 67: 992–997.

Puri A, Sethi R, Singh B, et al. Paeripartum cardiomyopathy presenting with ventricular tachycardia: a rare presentation. Indian Pacing Electrophysiol J, 2009; 9: 186–189.

Priori SG, Blomstrom-Lundquist C, Mazzanti A, et al. 2015 ESC Guidelines for management of patients with ventricular arrhythmias and prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society (ESC) Endorsed by: Association for European Paediatric and Congenital (AEPC). Eur Heart J. 2015; 36: 2793- 2867.

Lemery R, Brugada P, Bella PD, et al. Nonischemic ventricular tachycardia. Clinical course and long-term follow-up in patients without clinically overt heart disease. Circulation 1989; 79: 990- 999.

Chandra NC, Gates EA, Thamer M, et al. Conservative treatment of paroxysmal ventricular tachycardia during pregnancy. Clin Cardiol 1991; 14: 347–350.

Brodsky M, Doria R, Allen B. New-onset ventricular tachycardia during pregnancy Am Heart J 1992; 123: 933–934.

Cleary-Goldman J, Salva CR, Infeld JI, et al. Verapamil-sensitive idiopathic left ventricular tachycardia in pregnancy. J Matern Fetal Neonatal Med. 2003; 14: 132–135.

Rashba EJ, Zareba W, Moss AJ, et al. Influence of pregnancy on the risk for cardiac events in patients with hereditary long QT syndrome, LQTS Investigators. Circulation 1998; 97: 451–456.

Michalak M, Cacko A, Grabowski M. Pregnancy-related physiological changes in cardiovascular system observed with implantable cardioverter-defibrillator. Kardiol Pol. 2014; 72(7): 656.

Abello M, Peinado R, Merin JL, et al. Cardioverter Defibrillator implantation in pregnant woman guided with transesophageal echocardiography. Pacing Clin Electrophysiol 2003; 26: 1913–1914.

Joglar JA, Page RL. Management of arrhythmia syndromes during pregnancy. Curr Opin Cardiol 2014; 29: 36–44.

Hidaka N, Chiba Y, Fukushima K, et al. Pregnant women with complete atrioventricular block: perinatal risks and review of management. Pacing Clin Electrophysiol 2011; 34: 1161–1176.

Antonelli D, Bloch L, Rosenfeld T, et al. Implantation of permanent dual chamber pacemaker in pregnant woman by transesophageal echocardiographic guidance. Pacing Clin Electrophysiol 1999; 22: 534–535.

Tuzeu V, Kiline OU. Implantable cardioverter defibrillator implantation without using fluoroscopy in pregnant patient. Pacing Clin Electrophysiol 2012; 35: e265–266.




DOI: http://dx.doi.org/10.20418%2Fjrcd.vol2no6.208

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