Management and perinatal outcomes of cardiac arrhythmias in pregnancy

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Arrhythmias in pregnancy are common and can cause significant complications. The decision to use drug therapy or invasive treatment in pregnancy must have absolutely reasons. Data on perinatal outcomes in pregnant women with arrhythmias is limited. Objective The aim of our study is to observe the characteristics and prognosis of cardiac arrhythmias in pregnant women. Methods 72 pregnant women with arrhythmias have been included (single-center, prospectively study). Mean age of patients: 28,34 ± 5,25years, mean gestation age 22,37 ± 6,77 weeks. Clinical characteristics of patients, obstetric and neonatal outcomes were documented. Results The most common reported arrhythmias were supraventricular tachycardia (n = 32; 44%). This was followed by premature contractions (n = 29; 40%). Advanced heart block (n = 7; 10%) and ventricular tachycardia (n = 4; 6%) were exceedingly rare during pregnancy. Arrhythmias was benign in 12 patients (17%) and did not require drug therapy. Administration of antiarrhythmic treatment was justified when symptoms were very frequent and cause haemodynamic instability (n = 52; 65,7%). In patients with drug refractory and dangerous rhythm disturbances (n = 22; 31%) were performed catheter ablation by using 3D navigation system without fluoroscopy. Permanent pacemaker was implanted in 7 cases (10%) of third-degree atrioventricular block. Interventions were effective in all cases without adverse outcome. In the majority of cases were spontaneus vaginal (n = 48; 66,7%) or vaginal-assisted (n = 6; 8,3%) delivery. Eighteen pregnancies (25%) were delivered by cesarean section. Intrapartum hemorrhage was 350,4 ± 238,2 ml. Maternal cardiac events and obstetric complications were none declared. There were 72 live births (in all pregnancies). Fetal birth weight was 3407,39 ± 785,61 grams, 5 minute Apgar was 8,47 ± 1,6. There were no maternal and fetal mortality. Conclusions supraventricular tachycardia and premature beats are common in pregnancy. Spontaneous vaginal delivery is more likely in this patients. Major maternal and fetal adverse outcomes are infrequent in pregnant women with arrhythmias.