Arrhythmia during gestation: from diagnosis to follow-up

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Abstract Background Although arrhythmia is common cardiac complication during gestation, data on perinatal and neonatal outcomes in pregnant women with different arrhythmia management is limited. Purpose To explore clinical characteristics and outcomes of different management strategies in pregnant women with arrhythmias. Methods In this single-center, prospectively study we consequently included 87 cases of arrhythmias in pregnant (mean age 26.7±3.5 years, mean gestation age 24.6 ±3.3 weeks). Clinical characteristics, obstetric and neonatal outcomes were compared due to different arrhythmia management strategies: dynamic observation (the 1st group), antiarrhythmic therapy (the 2nd group) and catheter ablation (the 3rd group) within 12 month follow-up. Results Supraventricular tachycardia (n=47; 54%) was the most common arrhythmia in pregnant. Premature contraction was detected in 34 cases (39%). Cases of ventricular tachycardia (n=6; 7%) was rare during gestation. Benign course of arrhythmia was in 15 cases (17.2%) and do not require drug therapy or intervention. Antiarrhythmic drug was used for symptomatic patients with haemodynamic instability (n=28, 32.2%). Catheter ablation performed in cases of drug refractory and severe arrhythmias (n=44, 50.5%). The procedure performed under the guidance of CARTO (n=21; 47.7%) and Ensite Precision systems (n=23; 52.3%) without fluoroscopy and were successful in all cases (100%). The further course of gestation characterized by occurring increased incidence of uterine contractile activity (n=2, 4.5%, p=0.464) and placental abruption (n=2, 4.5%, p=0.464) only after catheter ablation while other complications were in all groups: uterine blood flow violation (n=6, 40% vs. n=4, 14.3% vs. n=6, 13.6%, p=0.168) and preeclampsia (n=1, 6.7% vs. n=1, 3.6% vs. n=2, 4.5%, p=0.730). Obstetric outcomes characterized by prevalence of vaginal delivery in all groups (n=13, 86.7% vs. n=22, 78.6% vs. n=37, 84%, p=0.465). Neonatal outcomes characterized by normal range of fetal birth weight and 5 minute Apgar score in all groups (3140.7±321.2 vs. 3265,3±290,1 vs. 3312,3±209,8 grams, p=0.701 and 8,6±1,1 vs. 8,5±1,2 vs. 8,6±1,2, p=0.721 respectively). There was no incidence of maternal and fetal mortality and arrhythmia recurrence after ablation in follow-up. Conclusions Supraventricular tachycardia is common in pregnancy. Arrhythmias in pregnant characterized by benign gestation course and outcomes regardless different management.