Abstract 12902: Supraventricular Tachycardia During Pregnancy is Independently Associated With Adverse Obstetrical Outcomes

Abstract

Introduction: Supraventricular tachycardias (SVT) are the most frequently encountered arrhythmias in pregnancy, however, their clinical significance is unclear. Hypothesis: We report the prevalence, describe the management and explore the association between SVT and adverse obstetric outcomes in women with structurally normal hearts. Methods: This is a case-control study of primiparous and multiparous women without history of cesarean section (CS), and no known cardiac diagnosis admitted in labor to one of 8 Northwell Health hospitals between January 2015 and August 2022. The study group consisted of women with at least one SVT episode during pregnancy and the control group was randomly selected in a 4:1 ratio. Multivariate analysis was used to examine the association between occurrence of SVT during pregnancy and incidence of cesarean section (CS), preterm labor (PTL), and length of stay (LOS). Results: Of 141,769 women meeting the inclusion criteria, SVT diagnosis was confirmed in 122. Of those, 76 (age 33.2±4.8 years) had at least 1 symptomatic episode during pregnancy. For the women with known SVT diagnosis prior to pregnancy, medical therapy with any antiarrhythmic agent was not associated with reduction of SVT recurrence during pregnancy (OR 1.07, 95% CI 0.41-2.80 p=0.89). On the contrary, catheter ablation prior to pregnancy was associated with significant reduction of SVT recurrence (OR 0.09, 95% CI 0.04-0.23, p<0.0001). Women with SVT during pregnancy had a higher incidence of CS (39.5% vs 27.0%. p=0.03), and PLT (30.3% vs 8.6%, p<0.001) compared to the control group. After adjusting for age and parity, SVT during pregnancy was independent predictor of CS, particularly elective CS (OR 2.89 95% CI 1.06-7.89) and PTL (OR 4.37 95%CI 2.30-8.31). Conclusions: SVT occurs in about 1 in every 1,000 women during pregnancy and is associated with higher rates of CS, particularly scheduled, and PLT. Any history of SVT should be sought and addressed during preconception counselling and SVT episodes during pregnancy should be approached in a multidisciplinary way to mitigate the risk of CS and associated complications.