Abstract
Incidence of atrial fibrillation (AF) during pregnancy is expected to increase in parallel to the increased mean age of conception and the percentage of pregnant women with congenital or structural heart disease. Cases of AF in pregnant women should be managed by an experienced cardiologist or an electrophysiologist. In terms of treatment options, direct cardioversion is highly effective and safe in pregnancy. Therefore, it should be preferred over pharmacologic cardioversion with intravenous ibutilide or flecainide. In contrast, amiodarone is not recommended. In respect to rate-control pharmaceutic agents, beta-blockers (except for atenolol) and digoxin should be considered as the first treatment option with the widest experience of use. Interventional techniques are usually deferred after the end of pregnancy; however, catheter ablation could be offered in selected cases of atrial flutter refractory to medication, preferably during the second trimester. To this end, fluoroless techniques must be employed. Finally, vitamin K antagonists (VKAs) are recommended after the first trimester whilst non-VKA oral anticoagulants should be avoided given the limited experience in this special population. Low molecular weight heparin is an acceptable and effective treatment for anticoagulation but periodic evaluation of anti-Xa factor is warranted. Of note, tools currently used for prediction of stroke risk in non-pregnant patients with AF have not been validated in pregnancy. Overall, treatment of AF in pregnancy must be balanced between expected benefit and potential harm and constantly updated according to mother’s symptoms, fetus’ signs and clinical response. Further studies are needed to evaluate optimal therapeutic strategies for supraventricular arrhythmias in pregnancy.
Published Version
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