2023 HRS expert consensus statement on the management of arrhythmias during pregnancy

Joglar, José A.; Kapa, Suraj; Saarel, Elizabeth V.; Dubin, Anne M.; Görenek, Bülent; Hameed, Afshan B.; Melo, Sissy Lara de; Leal, Miguel A.; Mondésert, Blandine; Pacheco, Luis D.; Robinson, Melissa; Sarkozy, Andrea; Silversides, Candice; Spears, Danna; Srinivas, Sindhu K.; Strasburger, Janette F.; Tedrow, Usha B.; Wright, Jennifer M.; Zelop, Carolyn M.; Zentner, Dominica

doi:10.1016/j.hrthm.2023.05.017

Cited by 24 publications

(21 citation statements)

References 441 publications

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“…It should be noted that, reflecting the local standard practice, no patients in our series had WCD. Consistently, in a recent consensus document of the Heart Rhythm Society ( 73 ), it has been reported that the criteria for early ICD placement should be more stringent compared to other cardiac conditions. This particularly applies to patients presenting with LVEF below 30% in conjunction with a LV end-diastolic diameter equal to or exceeding 60 mm, because of the low likelihood of LVRR even in the long term ( 89 ).…”

Section: Critical Review Of the Literaturementioning

confidence: 67%

“…An evidence-based overview of the available treatment options to manage arrhythmias in PPCM is presented in Table 5 . The traditional RAAS-inhibitors, as well as angiotensin receptor-neprilysin inhibitors and mineralocorticoid receptor antagonists, are contraindicated during pregnancy and can be only used in the post-partum period ( 2 – 4 , 73 ), as occurred in our cases. Episodes of acute HF are managed by oxygen administration, fluid restriction, loop diuretics, nitrates and vasodilators as hydralazine ( 8 , 9 , 72 ).…”

Section: Critical Review Of the Literaturementioning

confidence: 83%

“…Among antiarrhythmic drugs, the use of amiodarone is restricted during pregnancy, since it can induce fetal hypothyroidism, growth retardation, and prematurity ( 73 ). Most betablockers, including sotalol, and central calcium-channel antagonists as verapamil, are well tolerated during pregnancy ( 60 , 73 ). Instead, digoxin or flecainide should be used when benefits overwhelm risks ( 73 – 75 ), such as in the event of fetal arrhythmias ( 87 ).…”

Section: Critical Review Of the Literaturementioning

confidence: 99%

“…Most betablockers, including sotalol, and central calcium-channel antagonists as verapamil, are well tolerated during pregnancy ( 60 , 73 ). Instead, digoxin or flecainide should be used when benefits overwhelm risks ( 73 – 75 ), such as in the event of fetal arrhythmias ( 87 ). For unstable arrhythmias, electrical cardioversion is a suitable and safe option during pregnancy, but the presence of an obstetrician in advisable in light of the risk of increased intrauterine activity ( 11 , 73 ).…”

Section: Critical Review Of the Literaturementioning

confidence: 99%

“…Instead, digoxin or flecainide should be used when benefits overwhelm risks ( 73 – 75 ), such as in the event of fetal arrhythmias ( 87 ). For unstable arrhythmias, electrical cardioversion is a suitable and safe option during pregnancy, but the presence of an obstetrician in advisable in light of the risk of increased intrauterine activity ( 11 , 73 ). In our experience, betablocker and antiarrhythmic agents were employed in 63% and 44% of patients, respectively, without safety issues when used during pregnancy.…”

Section: Critical Review Of the Literaturementioning

confidence: 99%

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The “arrhythmic” presentation of peripartum cardiomyopathy: case series and critical review of the literature

Peretto,

Micaglio,

Ciconte

et al. 2024

Front. Cardiovasc. Med.

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Peripartum Cardiomyopathy (PPCM) is a polymorphic myocardial disease occurring late during pregnancy or early after delivery. While reduced systolic function and heart failure (HF) symptoms have been widely described, there is still a lack of reports about the arrhythmic manifestations of the disease. Most importantly, a broad range of unidentified pre-existing conditions, which may be missed by general practitioners and gynecologists, must be considered in differential diagnosis. The issue is relevant since some arrhythmias are associated to sudden cardiac death occurring in young patients, and the overall risk does not cease during the early postpartum period. This is why multimodality diagnostic workup and multidisciplinary management are highly suggested for these patients. We reported a series of 16 patients diagnosed with PPCM following arrhythmic clinical presentation. Both inpatients and outpatients were identified retrospectively. We performed several tests to identify the arrhythmic phenomena, inflammation and fibrosis presence. Cardiomyopathies phenotypes were reclassified in compliance with the updated ESC guidelines recommendations. Arrhythmias were documented in all the patients during the first cardiological assessment. PVC were the most common recorder arrhythmias, followed by VF, NSVT, AF, CSD.

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Section: Critical Review Of the Literaturementioning

confidence: 67%