Chapter 60 - Supraventricular tachycardia in pregnancy

Abstract

Supraventricular tachycardia (SVT) can occur in pregnant women with or without structural heart disease. SVT remains uncommon in pregnancy, and atrial fibrillation is now the most frequent supraventricular arrhythmia in pregnancy. Maternal physiologic changes such as increased intravascular volume can predispose to SVT and other arrhythmias in pregnancy. Although considered benign, SVT can be associated with adverse maternal and fetal outcome, especially among those with pre-existing structural heart disease. The clinical evaluation of SVT in pregnancy includes detailed history and physical examination. Important investigations include 12 lead ECG during SVT and sinus rhythm and echocardiography. The general management centers on arrhythmia avoidance during pregnancy by ablation of known SVT before pregnancy and involving a multidisciplinary care team for patients presenting 1st time during pregnancy. Acute management of SVT includes vagal maneuvers, pharmacotherapy and cardioversion for patients with hemodynamically unstable SVT. Chronic management includes pharmacotherapy with AV nodal blocking agents, anti-arrhythmic therapy, or catheter ablation in tertiary care centers after extensive consideration of risks and benefits to the mother and the fetus.