Arrhythmias in Pregnancy

Tamirisa, Kamala P.; Elkayam, Uri; Briller, Joan; Mason, Pamela; Pillarisetti, Jayasree; Merchant, Faisal M.; Patel, Hena; Lakkireddy, Dhanunjaya; Russo, Andrea M.; Volgman, Annabelle Santos; Vaseghi, Marmar

doi:10.1016/j.jacep.2021.10.004

Cited by 57 publications

(107 citation statements)

References 137 publications

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“…The prevalence of arrhythmias in pregnancy has been increasing over the past two decades in the U.S. [ 6 ]. This rise is attributed to the prevalence of CVD associated with increasing maternal age and other comorbidities such as hypertension, obesity, and diabetes mellitus [ 7 , 8 , 9 ]. Premature atrial and ventricular contractions are common due to hormonal and volume changes; apart from these, the most common maternal arrhythmias in pregnancy in the order of observed prevalence are supraventricular arrhythmias, atrial fibrillation, and ventricular arrhythmias [ 6 ].…”

Section: Arrhythmias In Pregnancymentioning

confidence: 99%

“…In women with normal hearts, SVT is more likely due to atrioventricular nodal reentrant and/or atrioventricular reentrant tachycardias. Given the involvement of the atrioventricular node in the etiology and mechanism of these arrhythmias, vagal maneuvers are effective and the first-line treatment strategy [ 7 ]. Adenosine can be safely used in pregnancy and is the medication of choice for the termination of maternal SVT [ 10 ].…”

Section: Arrhythmias In Pregnancymentioning

confidence: 99%

“…Calcium channel blockers (verapamil and diltiazem) are the second line of management. Digoxin is a safe treatment option for rate control [ 7 ].…”

Section: Arrhythmias In Pregnancymentioning

confidence: 99%

“…Flecainide can be safely used to treat SVT in structurally normal hearts in both the mother and fetus, though rarely, neonatal toxicity can occur [ 13 ]. In the setting of hemodynamic compromise, as with other arrhythmias, cardioversion can be safely performed in pregnancy, and defibrillation pads should be placed away from the gravid uterus [ 7 ]. Successful ablation of SVT has been reported during pregnancy with minimal fluoroscopy [ 14 , 15 , 16 ]; however, deferring ablation to the postpartum period is preferred.…”

Section: Arrhythmias In Pregnancymentioning

confidence: 99%

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Arrhythmias and Heart Failure in Pregnancy: A Dialogue on Multidisciplinary Collaboration

Tamirisa

Dye

Bond

et al. 2022

JCDD

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The prevalence of CVD in pregnant people is estimated to be around 1 to 4%, and it is imperative that clinicians that care for obstetric patients can promptly and accurately diagnose and manage common cardiovascular conditions as well as understand when to promptly refer to a high-risk obstetrics team for a multidisciplinary approach for managing more complex patients. In pregnant patients with CVD, arrhythmias and heart failure (HF) are the most common complications that arise. The difficulty in the management of these patients arises from variable degrees of severity of both arrhythmia and heart failure presentation. For example, arrhythmia-based complications in pregnancy can range from isolated premature ventricular contractions to life-threatening arrhythmias such as sustained ventricular tachycardia. HF also has variable manifestations in pregnant patients ranging from mild left ventricular impairment to patients with advanced heart failure with acute decompensated HF. In high-risk patients, a collaboration between the general obstetrics, maternal-fetal medicine, and cardiovascular teams (which may include cardio-obstetrics, electrophysiology, adult congenital, or advanced HF)—physicians, nurses and allied professionals—can provide the multidisciplinary approach necessary to properly risk-stratify these women and provide appropriate management to improve outcomes.

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Section: Arrhythmias In Pregnancymentioning

confidence: 99%

Section: Arrhythmias In Pregnancymentioning

confidence: 99%

“…Calcium channel blockers (verapamil and diltiazem) are the second line of management. Digoxin is a safe treatment option for rate control [ 7 ].…”

Section: Arrhythmias In Pregnancymentioning

confidence: 99%

Section: Arrhythmias In Pregnancymentioning

confidence: 99%

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Arrhythmias and Heart Failure in Pregnancy: A Dialogue on Multidisciplinary Collaboration

Tamirisa

Dye

Bond

et al. 2022

JCDD

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“…One study demonstrated that with proper abdominal shielding, theoretical fetal exposure during a catheter ablation procedure was <1 mGy 25 . Nevertheless, given the risks above, fluoroscopic free ablation is gaining wider acceptance as an alternative to treat pregnant patients with refractory arrhythmias 26 .…”

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confidence: 99%

Comparison Of Minimal Versus Zero Fluoroscopic Catheter Ablations In Gestational Supraventricular Arrhythmias

You

Pagan

Mitra

2022

Preprint

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Introduction: Management of gestational supraventricular tachycardia (SVT) is challenging and requires a multidisciplinary approach for optimal management. Antiarrhythmic pharmacologic therapy has variable efficacy and carries potential risks to both mother and fetus. Catheter ablation during pregnancy has traditionally been considered a last option due to procedural safety and ionizing radiation risks. Recent advances including intracardiac echocardiography and multi-electrode electroanatomic mapping have greatly enhanced the safety and efficacy profile to successfully perform ablations with minimal to no fluoroscopy even during pregnancy; however, most of the literature publications are case reports. Though the use of fluoroscopy-guided catheter ablations for refractory cardiac arrhythmias in pregnancy have been extensively studied, there are still a paucity of data about the efficacy, safety, and aggregate outcomes of purely zero-fluoroscopic ablations in comparison to minimal fluoroscopic approaches. Methods: A literature search was performed for catheter ablations in the past fifteen years for gestational arrhythmias that used minimal or no fluoroscopy. Sixteen cases describing catheter ablations with zero-fluoroscopy were compared to twenty-four cases using minimal fluoroscopy, defined as total documented exposure time of less than 10 minutes. Baseline characteristics, techniques, and outcomes of both groups were compared. Results: Analysis of both groups demonstrated that zero-fluoroscopic approaches for treatment of gestational SVT, though underutilized, have comparable successful outcomes without additional risk compared to minimally fluoroscopic procedures. Utilization of electroanatomic mapping with or without concomitant intracardiac echocardiography in the zero-fluoroscopy group further demonstrated equal efficacy rates of successful ablation when compared to the control group. Furthermore, there were no reported immediate or long term periprocedural complications in either group, including delivery outcomes. Conclusions: Zero-fluoroscopy catheter ablation for SVT in pregnancy appears to be as effective and safe when compared to minimal fluoroscopy ablations while eliminating the theoretical risks of ionizing radiation.

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Diagnosis and Management of Paroxysmal Supraventricular Tachycardia

Peng,

Zei

2024

JAMA

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ImportanceParoxysmal supraventricular tachycardia (PSVT), defined as tachyarrhythmias that originate from or conduct through the atria or atrioventricular node with abrupt onset, affects 168 to 332 per 100 000 individuals. Untreated PSVT is associated with adverse outcomes including high symptom burden and tachycardia-mediated cardiomyopathy.ObservationsApproximately 50% of patients with PSVT are aged 45 to 64 years and 67.5% are female. Most common symptoms include palpitations (86%), chest discomfort (47%), and dyspnea (38%). Patients may rarely develop tachycardia-mediated cardiomyopathy (1%) due to PSVT. Diagnosis is made on electrocardiogram during an arrhythmic event or using ambulatory monitoring. First-line acute therapy for hemodynamically stable patients includes vagal maneuvers such as the modified Valsalva maneuver (43% effective) and intravenous adenosine (91% effective). Emergent cardioversion is recommended for patients who are hemodynamically unstable. Catheter ablation is safe, highly effective, and recommended as first-line therapy to prevent recurrence of PSVT. Meta-analysis of observational studies shows single catheter ablation procedure success rates of 94.3% to 98.5%. Evidence is limited for the effectiveness of long-term pharmacotherapy to prevent PSVT. Nonetheless, guidelines recommend therapies including calcium channel blockers, β-blockers, and antiarrhythmic agents as management options.Conclusion and RelevanceParoxysmal SVT affects both adult and pediatric populations and is generally a benign condition. Catheter ablation is the most effective therapy to prevent recurrent PSVT. Pharmacotherapy is an important component of acute and long-term management of PSVT.

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Arrhythmias in Pregnancy

Cited by 57 publications

References 137 publications

Arrhythmias and Heart Failure in Pregnancy: A Dialogue on Multidisciplinary Collaboration

Arrhythmias and Heart Failure in Pregnancy: A Dialogue on Multidisciplinary Collaboration

Comparison Of Minimal Versus Zero Fluoroscopic Catheter Ablations In Gestational Supraventricular Arrhythmias

Diagnosis and Management of Paroxysmal Supraventricular Tachycardia

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