Journal of Rare Cardiovascular Diseases

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

 

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

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.