Hormone Sensitive Idiopathic Ventricular Tachycardia Associated With Pregnancy: Successful Induction With Progesterone and Radiofrequency Ablation

Abstract

Successful Induction With Progesterone and Radiofrequency Ablation. Verapamil-sensitive idiopathic left ventricular tachycardia in pregnancy is a rare diagnosis. We report a case of a primigravida female with new onset fascicular ventricular tachycardia that was managed with oral verapamil. Post pregnancy, the tachycardia was not inducible in the electrophysioplogy lab. Progesterone, a hormone associated with pregnant state, was used to successfully induce the tachycardia, which was ablated. This is the first reported case of an idiopathic ventricular tachycardia associated with pregnancy that could be induced later by recreating the hormonal milieu associated with pregnant state.

Contemporary Management of Arrhythmias During Pregnancy

“…Estradiol and progesterone have been shown to be proarrhythmic in animal studies and in case reports of pregnant patients with arrhythmias. 6,7 In addition, estrogen has been shown to increase the number of adrenergic receptors in the myocardium, and adrenergic responsiveness seems to be increased in pregnancy. 8,9 …”

“…Thus, a primary concern when administering AADs is the potential risk to the fetus. Organogenesis occurs in the first trimester (gestational weeks, [5][6][7][8][9][10], and the fetus is most sensitive to the effect of teratogens during this time. 10 Medications of modest risk that have long been effective in controlling significant arrhythmias should be continued in most clinical settings during this period as the stability of the patient may supersede the potential risks of the medication.…”

The investigation and management of broad complex tachycardia and ventricular standstill presenting in pregnancy: A case report

“…1 The neuroendocrine changes that occur in pregnancy have been postulated to drive arrhythmia: Makhija et al report the case of a pregnancy-related left ventricular outflow tract (LVOT) ventricular tachycardia (VT) that could not be induced during a post-delivery electrophysiology study until a progesterone challenge was introduced. 5 Similarly, Kotchetkov et al describe a pregnant woman with asthma and ventricular trigeminy, treated with nebulised salbutamol. After each nebuliser, this patient developed VT requiring treatment.…”

“…Palpitations in the absence of dysrhythmia are benign and there is anecdotal guidance on managing SVT in pregnancy with rate-controlling agents or adenosine without significant risk to the fetus. 1,5 Equally, VT originating from the ventricular outflow tracts can be treated with beta-blockade or verapamil. The main dilemmas in this case resulted from a tendency to bradycardia and asystole, interfering with safe rate control and necessitating a considered strategy for cardiovascular support during delivery.…”

Normal Heart Ventricular Tachycardia Associated with Pregnancy: Successful Treatment with Catheter Ablation

“…There have been reports of pregnancy related VT being successfully induced in the post partum period only following the administration of progesterone supplements. [3] On the other hand, an increase in central sympathetic activity has been reported in normal pregnancy and an increased sensitivity to circulating catecholamines during pregnancy has been proposed as a potential trigger for VT.[2]…”