Supraventricular tachycardia in pregnancy: a rare case series and dilemmatic antiarrhythmic drug choices in the rural area

Abstract

Background: The prevalence of cardiovascular disease in pregnancy is reported to be increasing and becoming a major cause of maternal morbidity and mortality. The incidence of arrhythmia during pregnancy has been linked to increased fetal mortality and complications. Arrhythmias can develop de novo during pregnancy or be exacerbated by pregnancy. Case Description: A 35-year-old (third trimester) and a 25-year-old (second trimester) woman complained of shortness of breath and palpitations. The first patient was in her sixth pregnancy, with three live births and two miscarriages. Meanwhile, the second patient was in her first pregnancy and had never miscarried. The first and second patients' pulse rates were 180 and 160 beats per minute, respectively. In both cases, 12-lead electrocardiography revealed an atrioventricular nodal re-entrant tachycardia rhythm. Initially, both patients were given carotid artery massages. The first patient's rhythm returned to normal sinus, but carotid artery massage failed in the second patient. Then, the second patient received a slow bolus of 0.5 mg digoxin IV. The heart rate returned to normal sinus rhythm following the observation. Both patients were admitted to the intensive care unit. Conclusion: Atrioventricular nodal re-entrant tachycardia is a type of paroxysmal supraventricular tachycardia. Effective management highly depends on both clinical presentation and the trimester of pregnancy. This arrhythmia can be treated with vagal maneuvers in mild cases. When vagal maneuvers fail, medical management is preferred. The main concern with using antiarrhythmic drugs during pregnancy is the risk of fetal harm and the decision should be tailored based.