Treatment for cardiac arrhythmias in pregnancy: Efficiency and safety

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Pregnancy with its physiological neurohumoral and hemodynamic changes may cause new-onset cardiac arrhythmia or worsen existing arrhythmias. It is important to single out the arrhythmias in pregnant women, which pose no risk for mother or fetus and therefore are not a contraindication to vaginal delivery and occasionally need no medical treatment. On the other hand, the arrhythmias, that impair hemodynamics and those that are referred to as the so-called potentially malignant and malignant cardiac arrhythmias, require specific pharmacotherapy and, in a number of cases, invasive treatments. Arrhythmias pharmacotherapeutic challenges in pregnant women are determined by that many antiarrhythmic agents may be harmful to the fetus and that the results of controlled trials of this problem are few and conflicting. The paper covers the current areas and some disputable issues of medical and surgical treatments for a wide spectrum of supraventricular and ventricular arrhythmias in pregnant women and gives practical recommendations for the use of different classes of antiarrhythmic agents in them to stop and prevent cardiac arrhythmias depending on their fetal safety and the pattern of maternal cardiovascular and concomitant diseases.