Management of tachyarrhythmias in pregnancy – A review

Abstract

The most common arrhythmias detected during pregnancy include sinus tachycardia, sinus bradycardia, and sinus arrhythmia, identified in 0.1% of pregnancies. Isolated premature atrial or ventricular arrhythmias are observed in 0.03% of pregnancies. Arrhythmias may become more frequent during pregnancy or may manifest for the first time.

Tachycardia in pregnancy: when to worry?

“…Supraventricular tachycardia (SVT) affects 0.02%-0.5% of pregnancies and include atrial tachycardias, atrial flutter, junctional tachycardia, atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardias (AVRT), the latter mediated by an accessory pathway. 10 Typically, an SVT is a narrow complex with an atrial rate over 100 bpm. Women with pre-existing SVT may experience an exacerbation during pregnancy and they can be treated successfully and safely during pregnancy using usual medical therapy such as adenosine (Table 1).…”

“…For women with more frequent episodes of SVT, preventative medication (such as beta-blockers or calcium-channel blockers) can be given once ventricular pre-excitation has been excluded. 10 Inappropriate sinus tachycardia (IST) is the occurrence of a faster than expected heart rate at unexpected times, for example, at rest rather than on exertion. It can occur for the first time in pregnancy and be associated with symptoms of palpitations.…”

Ivabradine use in pregnant women—treatment indications and pregnancy outcome: an evaluation of the German Embryotox database

“…In our case series, most women were treated (off-label) for supraventricular tachycardia using lower doses than recommended (5-7.5 mg twice daily). Supraventricular tachycardia is not uncommon, especially in younger women, and is expected in 0.02-0.5% of pregnancies [20]. Aggravation of symptoms during pregnancy is described in about 20-50% of women related to various mechanisms, including pregnancy-related increase in cardiac heart rate and output and hormonal changes [20].…”

“…In 2015, the HRS (Heart Rhythm Society) considered ivabradine as promising for treating patients with inappropriate sinus tachycardia (IST) [13], followed by a recommendation for ivabradine by the ACC (American College of Cardiology) in 2016 [14]-though only one small randomized controlled study has yet supported beneficial effects [21]. Although still not approved for this indication, recent ESC guidelines [15] also recommend ivabradine alone or in combination with a beta-blocker in symptomatic patients with IST, for the treatment of focal atrial tachycardia or for postural orthostatic tachycardia syndrome (POTS), a condition considered as common cause for orthostatic intolerance in women between 15 and 25 years [20,22] (Fig. 2).…”

Two years later

“…6 We also feature a topical (but non-COVID) review of the use of electronic cigarettes in pregnant women 7 and a comprehensive overview of tachyarrhythmias in pregnancy. 8…”