Atrial Fibrillation In Pregnancy Research Articles

Comparing the outcomes of rheumatic heart disease in pregnancy complicated with and without atrial fibrillation: A propensity score matched analysis

Atrial fibrillation (AF) may increase the risk of adverse maternal and fetal outcomes among pregnant with rheumatic valvular lesions (RHD). We aimed to assess the rate of occurrence of AF in pregnant with RHD and its impact on cardiac and maternal-fetal outcomes compared to those without it. The study group consisted of pregnant women with RHD and AF (cases) and a matched comparison group of pregnant women with RHD but without AF (controls) was derived from the database of pregnant women with RHD receiving care at our center between 2011 and 2021. Incidence of composite adverse outcomes(maternal death, heart failure, or thrombo-embolic events) and pregnancy outcomes were compared between them. Seventy-one (5.1%; 95%CI 4.1%-6.4%) pregnant women with RHD had AF during pregnancy and childbirth, most occurring in the late second or early third trimester. New-onset AF was diagnosed in 34 (47.9%) of them. After matching, the incidence of composite outcome was higher in women with AF (77.5% (95% CI 66.3%-85.7%) compared to women without AF (17.3%(95% CI 13.3% - 22.1%), p<0.001), with seven (9.9%) maternal deaths among cases and two (0.7%) in controls. Heart failure was the most common adverse cardiac event (26.7% vs. 4.2%, p<0.001, cases vs controls). Those with AF had higher odds (adjusted OR 56.6 (14.1 - 226.8)) of adverse cardiac outcomes after adjusting for other risk factors. The frequency of most non-cardiac pregnancy complications was similar in both groups. However, there was a trend towards a higher rate of miscarriage (16.9% vs. 9.9%), small-for-gestational-age babies(16.3 vs. 9.0%), and cesarean rates(31.9% vs. 18.3%) women with AF compared to those who did not experience AF. Atrial fibrillation in pregnancy among women with RHD was associated with an increased risk of maternal morbidity and mortality, with a trend towards an increase in some non-cardiac pregnancy complications compared to those pregnant women without AF. Our study results provide background data for developing and implementing a pregnancy-specific management strategy tailored to middle-income settings.

Lone atrial fibrillation: A case report on a rare complication of pregnancy

Atrial fibrillation (AF) is one of the most common arrhythmias and is a rare phenomenon seen in pregnant patients unless there is an underlying cardiopulmonary abnormality. Lone AF in pregnancy is a diagnosis of exclusion. A thorough workup including history, physical examination, imaging, and laboratory workup should be done diligently to exclude cardiopulmonary diseases (like hypertensive heart disease, congenital heart disease, valvular heart disease, asthma or chronic obstructive pulmonary disease, pulmonary embolism, rheumatic heart disease) and non-cardiac diseases (such as hyperthyroidism or electrolyte abnormalities or medications). There are very few case reports and studies published so far on this topic. This case report is on a pregnant patient without any significant past medical history who developed new-onset lone AF without any known cause and was managed with Diltiazem, which resulted in chemical cardioversion of atrial fibrillation with rapid ventricular rate to normal sinus rhythm.

Atrial fibrillation in pregnancy

Developing countries with higher prevalence of RHD encounter cases of AF in pregnancy. Szekely et al reported new onset of AF in 8% of pregnant patients with RHD.1 Dilatation of LA, elevated LA pressure and myocardial stretch due to mitral valve disease results in slow conduction velocities, increased dispersion of refractoriness and automaticity leading to AF. Occurrence is common in third trimester due to Increased HR, cardiac output, heart size, plasma volume, wall tension and decreased SVR. AF intensifies hemodynamic changes and predisposes to heart failure.2

Heart Failure Due to Mitral Stenosis Complicated Atrial Fibrillation in Pregnancy

Background. This case report aims to discuss the management of heart failure due to mitral stenosis with complications of atrial fibrillation in pregnancy.&#x0D; Case presentations. A 35-year-old pregnant woman came to the ER M. Djamil Hospital with complaints of shortness of breath 3 days before being admitted to the hospital. Complaints of shortness of breath accompanied by palpitations felt fast and irregular, appeared suddenly when the patient was resting, and lasted continuously. Physical examination showed a pulse rate of 120-130x/minute, increased jugular venous pressure, and palpable cardiac ictus 1 finger lateral to the left midclavicular at the V intercostal space. ECG examination revealed atrial fibrillation- rapid ventricular response (AF RVR). The patient was diagnosed with atrial fibrillation- rapid ventricular response et causa suspect mitral stenosis NYHA Fc III, et causa rheumatic heart disease.&#x0D; Conclusion. The management of atrial fibrillation rapid ventricular response in this patient was done by giving digoxin 0.25 mg orally. Patients are given anticoagulants to prevent thromboembolic complications. This patient was advised to undergo valve replacement surgery considering the degree of stenosis, complications, and a thorough assessment.

Arrhythmias in Pregnancy.

Increasing maternal mortality and incidence of arrhythmias in pregnancy have been noted over the past 2 decades in the United States. Pregnancy is associated with a greater risk of arrhythmias, and patients with a history of arrhythmias are at significant risk of arrhythmia recurrence during pregnancy. The incidence of atrial fibrillation in pregnancy is rising. This review discusses the management of tachyarrhythmias and bradyarrhythmias in pregnancy, including management of cardiac arrest. Management of fetal arrhythmias are also reviewed. For patients without structural heart disease, β-blocker therapy, especially propranolol and metoprolol, and antiarrhythmic drugs, such as flecainide and sotalol, can be safely used to treat tachyarrhythmias. As a last resort, catheter ablation with minimal fluoroscopy can be performed. Device implantation can be safely performed with minimal fluoroscopy and under echocardiographic or ultrasound guidance in patients with clear indications for devices during pregnancy. Because of rising maternal mortality in the United States, which is partly driven by increasing maternal age and comorbidities, a multidisciplinary and/or integrative approach to arrhythmia management from the prepartum to the postpartum period is needed.

Atrial fibrillation during pregnancy: a9-month period with limited options.

Pregnancy is aphysiological condition with reversible hemodynamic, neurohormonal and coagulation changes to the maternal body during this 9‑month period. The occurrence of atrial fibrillation (AF) is altogether rare among pregnant women, but necessitates immediate treatment und further work-up. Despite numerous pharmacological and invasive therapeutic modalities for AF in non-pregnant patients, very few options are considered safe enough for the fetus and the mother during pregnancy. Commonly used medications such as beta blockers, calcium channel antagonists, antiarrhythmic drugs and anticoagulation therapy must be carefully individualized according to the week of gestation and possible underlying comorbidities of the mother, thus highlighting the importance of an interdisciplinary evaluation by acardiologist and agynecologist. The current review summarizes the existing knowledge and treatment options for AF in pregnancy and suggests asimplified algorithm for this clinical constellation.

Betamethasone-Induced Atrial Fibrillation With Rapid Ventricular Response in Pregnancy: Case Report [05M

INTRODUCTION: Atrial fibrillation (AF) is a common cardiac arrhythmia but a rare occurrence in obstetrical patients. METHODS: A 24-year-old G6P2032 without significant medical history presented at 32 3/7 weeks gestation for routine obstetrical care. The fetus was suspected to have a hypoplastic right heart via fetal echocardiography at 24 5/7 weeks of gestation. She reported decreased fetal movement and audible fetal decelerations were noted during her exam. The patient was referred to the hospital and was noted to have category II fetal heart rate tracing (FHR). Considering the possibility of delivery before 37 weeks, she was given 12 mg betamethasone intramuscular injection at 32 3/7 weeks, which was repeated in 24 hours. The FHR improved to category I throughout prolonged monitoring. The following day, the patient returned complaining of severe palpitations, shortness of breath and was noted to have a pulse of 159 BPM while in AF with rapid ventricular response. She was started on an esmolol drip for rate control and failed to spontaneously convert to normal sinus rhythm (NSR). A transesophageal echocardiogram was performed, followed by direct current cardioversion (DCCV) with 150 J. The patient remained symptom-free in NSR after the DCCV and was discharged on 40 mg enoxaparin. Patient informed consent was obtained for submission of this case report. CONCLUSION: This case illustrates the uncommon, yet acknowledged risk of corticosteroid-induced AF. There have been reported cases of AF in pregnant patients receiving both betamethasone and beta-mimetics; however, these case reports attribute the AF to the beta-mimetics. This is believed to be the first reported case of betamethasone-induced AF in pregnancy.

Atrial Fibrillation in Pregnancy. A Safe Approach and Literature Review

Atrial Fibrillation in Pregnancy. A Safe Approach and Literature Review

P6055Impact of atrial fibrillation in pregnancy: an analysis from the nationwide inpatient sample

P6055Impact of atrial fibrillation in pregnancy: an analysis from the nationwide inpatient sample

Atrial fibrillation with a structurally normal heart in pregnancy: An international survey on current practice.

Little evidence exists for the optimal management of atrial fibrillation with a structurally normal heart in pregnancy. A survey was sent to members of two associations to obtain input on optimal management of atrial fibrillation in pregnancy. The survey presented four cases with respect to (1) baseline investigations; (2) rate versus rhythm control; (3) chemical versus electrical cardioversion; and (4) anticoagulation. Sixty-one responders from 11 countries participated. High agreement was noted for baseline investigations. A quarter (25%) of participants chose elective cardioversion even with a reversible precipitant. Electrical cardioversion was preferred over chemical (p < 0.05). Anticoagulation strategies were heterogeneous except in the presence of a left atrial appendage thrombus. This study revealed that there was little consensus in current practice in pregnancy beyond basic investigations. An adaptation of established guidelines to the pregnant population would require a meeting of Cardiologists with input from colleagues in Obstetric Medicine.

The unexpected pitter patter: new-onset atrial fibrillation in pregnancy.

Background. Atrial fibrillation is a relatively uncommon but dangerous complication of pregnancy. Emergency physicians must know how to treat both stable and unstable tachycardias in late pregnancy. In this case, a 40-year-old female with a cerclage due to incompetent cervix and previous preterm deliveries presents in new-onset atrial fibrillation. Case Report. A previously healthy 40-year-old African American G2 P1 female with a 23-week twin gestation complicated by an incompetent cervix requiring a cervical cerclage presented to the emergency department with intermittent palpitations and shortness of breath for the past two months. EMS noted the patient to have a tachydysrhythmia, atrial fibrillation with rapid ventricular response. She was placed on a diltiazem drip, which was titrated to 15 mg/hr without successful rate control. Her heart rate remained in the 130s and the rhythm continued to be atrial fibrillation with RVR. Digoxin was then added as a second agent, and discussions about the potential risks of cardioversion in pregnancy ensued. Fortunately, the patient converted to sinus rhythm before cardioversion became necessary. The digoxin was discontinued; the diltiazem was also discontinued after the patient subsequently developed hypotension. “Why Should Emergency Physicians Be Aware of This?” New-onset atrial fibrillation is rare in pregnancy but can increase the mortality and morbidity of the mother and fetus if not treated promptly.

Atrial Fibrillation in Pregnancy

BACKGROUND: Physiologic changes of pregnancy can predispose women to cardiac arrhythmias. Atrial fibrillation is rare in pregnancy and usually occurs in women with underlying cardiac anomalies. CASE: A young woman at 22 weeks of gestation presented with new-onset atrial fibrillation with rapid ventricular response. Thorough evaluation revealed atrial fibrillation with no underlying cause and ultimately required treatment with electrical cardioversion. CONCLUSION: Lone atrial fibrillation in pregnancy requires exclusion of all possible etiologies before diagnosis. Cardioversion is the treatment of choice. Women with persistent atrial fibrillation require anticoagulation and rate control, as well as fetal growth surveillance and antenatal testing.

Atrial Fibrillation in Pregnancy

Physiologic changes of pregnancy can predispose women to cardiac arrhythmias. Atrial fibrillation is rare in pregnancy and usually occurs in women with underlying cardiac anomalies. A young woman at 22 weeks of gestation presented with new-onset atrial fibrillation with rapid ventricular response. Thorough evaluation revealed atrial fibrillation with no underlying cause and ultimately required treatment with electrical cardioversion. Lone atrial fibrillation in pregnancy requires exclusion of all possible etiologies before diagnosis. Cardioversion is the treatment of choice. Women with persistent atrial fibrillation require anticoagulation and rate control, as well as fetal growth surveillance and antenatal testing.

Management of Atrial Fibrillation in Pregnancy.

Pregnancy is accompanied by a variety of cardiovascular changes in normal women; all of these changes are thought to promote arrhythmogenesis. Atrial fibrillation is unusual during pregnancy and it can represent a benign, self-limited lone atrial fibrillation or can be hemodynamically significant in parturient with or without structural heart disease. Management of atrial fibrillation should be the same as in non-pregnant women, but requires faster intervention, even in patients with a normal heart function, and cautious use of medication to avoid harm to the fetus. We might remember that synchronized electrical cardioversion has been performed safely during all stages of pregnancy.

Management of Atrial Fibrillation in Pregnancy

Management of Atrial Fibrillation in Pregnancy

Atrial fibrillation in pregnancy associated with oral terbutaline

BACKGROUND: Terbutaline has direct effects on the cardiac conduction system, but when used to treat preterm labor it is rarely associated with clinically significant cardiac arrhythmias. Commonly used drug references did not list atrial fibrillation as a complication of terbutaline, and our literature search found only one case of atrial fibrillation that occurred with parenteral administration. CASE: A 30-year-old gravida 1 carrying a twin gestation at 35 weeks was taking 2.5 mg oral terbutaline four times daily for premature labor. She developed atrial fibrillation and was ultimately treated by chemical cardioversion with procainamide to restore normal sinus rhythm. CONCLUSION: This is the first report of atrial fibrillation during pregnancy associated with oral terbutaline. Atrial fibrillation should be added as a complication of oral terbutaline therapy.