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Cardiac Arrhythmias and Pregnancy

  • Ciorsti MacIntyre
  • Chinyere Iwuala
  • Ratika Parkash
Pregnancy and Cardiovascular Disease (N Scott, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pregnancy and Cardiovascular Disease

Abstract

Purpose of reviews

In this review, the challenges of managing cardiac arrhythmias and syncope in the setting of pregnancy will be discussed.

Recent findings

Arrhythmias in pregnancy are increasing, as diagnostic and therapeutic options have advanced and women are older at the time of gestation. Atrial fibrillation has become the most common arrhythmia in pregnancy. Inherited arrhythmia has become a more common entity, with advances in treatments and genetic testing, and require specialized treatments in pregnancy.

Summary

The majority of arrhythmias in pregnancy are benign. The potential risk of increased cardiac morbidity and mortality exists for mother and fetus, especially in women with structural heart disease, which is becoming increasingly common. Early evaluation, diagnosis, and appropriate treatment are necessary to achieve optimal outcomes for both mother and fetus.

Keywords

Pregnancy Arrhythmia Syncope 

Notes

Compliance with Ethical Standards

Conflict of Interest

Ciorsti MacIntyre, Chinyere Iwuala, and Ratika Parkash each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

  1. 1.
    Haissaguerre M, Shoda M, Jais P, Nogami A, Shah DC, Kautzner J, et al. Mapping and ablation of idiopathic ventricular fibrillation. Circulation. 2002;106:962–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Noda T, Shimizu W, Taguchi A, Aiba T, Satomi K, Suyama K, et al. Malignant entity of idiopathic ventricular fibrillation and polymorphic ventricular tachycardia initiated by premature extrasystoles originating from the right ventricular outflow tract. J Am Coll Cardiol. 2005;46:1288–94.CrossRefPubMedGoogle Scholar
  3. 3.
    Webster J. Haemodynamic changes in pregnancy. J Hypertens. 2014;32:742–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Boardman H, Ormerod O, Leeson P. Haemodynamic changes in pregnancy: what can we learn from combined datasets? Heart. 2016;102:490–1.CrossRefPubMedGoogle Scholar
  5. 5.
    Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016;27:89–94.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Silversides CK. Physiological changes in pregnancy. In: C. A. Warnes, C. Oakley, eds. Heart disease in pregnancy. Massachussetts: Blackwell Publishing; 2007.Google Scholar
  7. 7.
    Mahendru AA, Everett TR, Wilkinson IB, Lees CC, McEniery CM. A longitudinal study of maternal cardiovascular function from preconception to the postpartum period. J Hypertens. 2014;32:849–56.CrossRefPubMedGoogle Scholar
  8. 8.
    Sanghavi M, Rutherford JD. Cardiovascular physiology of pregnancy. Circulation. 2014;130:1003–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Datta S KB, Segal S. Maternal physiologic changes during pregnancy, labor and the post partum period Obstetric Anaesthesia Handbook New York: Springer; 2010: 1–14.Google Scholar
  10. 10.
    Kuhn JC, Falk RS, Langesaeter E. Haemodynamic changes during labour: continuous minimally invasive monitoring in 20 healthy parturients. Int J Obstet Anesth. 2017;31:74–83.CrossRefPubMedGoogle Scholar
  11. 11.
    Henry D, Gonzalez JM, Harris IS, Sparks TN, Killion M, Thiet MP, et al. Maternal arrhythmia and perinatal outcomes. J Perinatol. 2016;36:823–7.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Joglar JA, Page RL. Management of arrhythmia syndromes during pregnancy. Curr Opin Cardiol. 2014;29:36–44.CrossRefPubMedGoogle Scholar
  13. 13.
    Vaidya VR, Arora S, Patel N, Badheka AO, Patel N, Agnihotri K, et al. Burden of arrhythmia in pregnancy. Circulation. 2017;135:619–21.CrossRefPubMedGoogle Scholar
  14. 14.
    Bett GC. Hormones and sex differences: changes in cardiac electrophysiology with pregnancy. Clin Sci (Lond). 2016;130:747–59.CrossRefGoogle Scholar
  15. 15.
    Shotan A, Ostrzega E, Mehra A, Johnson JV, Elkayam U. Incidence of arrhythmias in normal pregnancy and relation to palpitations, dizziness, and syncope. Am J Cardiol. 1997;79:1061–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Furenas E, Eriksson P, Wennerholm UB, Dellborg M. Effect of maternal age and cardiac disease severity on outcome of pregnancy in women with congenital heart disease. Int J Cardiol. 2017;243:197–203.CrossRefPubMedGoogle Scholar
  17. 17.
    Goya M, Casellas M, Merced C, Pijuan-Domenech A, Galian L, Dos L, et al. Predictors of obstetric complications in women with heart disease. J Matern Fetal Neonatal Med. 2016;29:2306–11.PubMedGoogle Scholar
  18. 18.
    Zaharatos J, St Pierre A, Cornell A, Pasalic E, Goodman D. Building U.S. capacity to review and prevent maternal deaths. J Women's Health (Larchmt). 2018;27:1–5.CrossRefGoogle Scholar
  19. 19.
    Goldstein SA, Ward CC. Congenital and acquired Valvular heart disease in pregnancy. Curr Cardiol Rep. 2017;19:96.CrossRefPubMedGoogle Scholar
  20. 20.
    Giannakoulas G, Ntiloudi D. Acquired cardiovascular disease in adult patients with congenital heart disease. Heart. 2017:heartjnl-2017-311997.Google Scholar
  21. 21.
    Laksman ZHL, Silversides CK. Cardiac arrhythmias during pregnancy: a clinical approach. Fetal Maternal Med Rev. 2011;22:123–43.CrossRefGoogle Scholar
  22. 22.
    Enderlin EA, Khaled KT, Oke L, Madmani M, Paydak H. Management of tachyarrhythmia during pregnancy. Turk Kardiyol Dern Ars. 2017;45:189–96.PubMedGoogle Scholar
  23. 23.
    European Society of G, Association for European Paediatric C, German Society for Gender M, Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, et al. ESC guidelines on the management of cardiovascular diseases during pregnancy: the task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:3147–97.CrossRefGoogle Scholar
  24. 24.
    Medicine UNLo. LactMed. 2018.Google Scholar
  25. 25.
    Pregnancy and Lactation Labeling (Drugs) Final Rule.Google Scholar
  26. 26.
    Silversides CK, Harris L, Haberer K, Sermer M, Colman JM, Siu SC. Recurrence rates of arrhythmias during pregnancy in women with previous tachyarrhythmia and impact on fetal and neonatal outcomes. Am J Cardiol. 2006;97:1206–12.CrossRefPubMedGoogle Scholar
  27. 27.
    Katritsis DG, Boriani G, Cosio FG, Jais P, Hindricks G, Josephson ME, et al. European heart rhythm association consensus document on the Management of Supraventricular Arrhythmias: endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE). Arrhythm Electrophysiol Rev. 2016;5:210–24.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Brubaker S, Long B, Koyfman A. Alternative treatment options for atrioventricular-nodal-reentry tachycardia: an emergency medicine review. J Emerg Med. 2018;54:198–206.CrossRefPubMedGoogle Scholar
  29. 29.
    Kozluk E, Piatkowska A, Kiliszek M, Lodzinski P, Malkowska S, Balsam P, et al. Catheter ablation of cardiac arrhythmias in pregnancy without fluoroscopy: a case control retrospective study. Adv Clin Exp Med. 2017;26:129–34.CrossRefPubMedGoogle Scholar
  30. 30.
    Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, et al. Evidence review committee Chairdouble d. 2015 ACC/AHA/HRS guideline for the Management of Adult Patients with Supraventricular Tachycardia: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society. Circulation. 2016;133:e471–505.CrossRefPubMedGoogle Scholar
  31. 31.
    January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130:e199–267.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2016;50:e1-e88.CrossRefPubMedGoogle Scholar
  33. 33.
    Lee MS, Chen W, Zhang Z, Duan L, Ng A, Spencer HT, et al. Atrial fibrillation and atrial flutter in pregnant women-a population-based study. J Am Heart Assoc. 2016;5:e003182.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Salam AM, Ertekin E, van Hagen IM, Al Suwaidi J, Ruys TPE, Johnson MR, et al. Atrial fibrillation or flutter during pregnancy in patients with structural heart disease. JACC Clin Electrophysiol. 2015;1:284.CrossRefPubMedGoogle Scholar
  35. 35.
    Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, van G, I, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De CR, De SJ, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas PE, Widimsky P, Vardas PE, Agladze V, Aliot E, Balabanski T, Blomstrom-Lundqvist C, Capucci A, Crijns H, Dahlof B, Folliguet T, Glikson M, Goethals M, Gulba DC, Ho SY, Klautz RJ, Kose S, McMurray J, Perrone FP, Raatikainen P, Salvador MJ, Schalij MJ, Shpektor A, Sousa J, Stepinska J, Uuetoa H, Zamorano JL and Zupan I. Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010.Google Scholar
  36. 36.
    Anugu VR, Nalluri N, Asti D, Gaddam S, Vazzana T, Lafferty J. New-onset lone atrial fibrillation in pregnancy. Ther Adv Cardiovasc Dis. 2016;10:274–6.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015;36:2793–867.CrossRefPubMedGoogle Scholar
  38. 38.
    Ertekin E, van Hagen IM, Salam AM, Ruys TP, Johnson MR, Popelova J, et al. Ventricular tachyarrhythmia during pregnancy in women with heart disease: data from the ROPAC, a registry from the European Society of Cardiology. Int J Cardiol. 2016;220:131–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Seth R, Moss AJ, McNitt S, Zareba W, Andrews ML, Qi M, et al. Long QT syndrome and pregnancy. J Am Coll Cardiol. 2007;49:1092–8.CrossRefPubMedGoogle Scholar
  40. 40.
    Rashba EJ, Zareba W, Moss AJ, Hall WJ, Robinson J, Locati EH, et al. Influence of pregnancy on the risk for cardiac events in patients with hereditary long QT syndrome. LQTS Investigators. Circulation. 1998;97:451–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Sharif-Kazemi MB, Emkanjoo Z, Tavoosi A, Kafi M, Kheirkhah J, Alizadeh A, et al. Electrical storm in Brugada syndrome during pregnancy. Pacing Clin Electrophysiol. 2011;34:e18–21.CrossRefPubMedGoogle Scholar
  42. 42.
    Romagano MP, Quinones JN, Ahnert A, Martinez R, Smulian JC. Catecholaminergic polymorphic ventricular tachycardia in pregnancy. Obstet Gynecol. 2016;127:735–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Autore C, Conte MR, Piccininno M, Bernabo P, Bonfiglio G, Bruzzi P, et al. Risk associated with pregnancy in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2002;40:1864–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Schinkel AF. Pregnancy in women with hypertrophic cardiomyopathy. Cardiol Rev. 2014;22:217–22.CrossRefPubMedGoogle Scholar
  45. 45.
    Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, et al. American College of Cardiology Foundation/American Heart Association task force on practice G. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Developed in collaboration with the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2011;58:e212–60.CrossRefPubMedGoogle Scholar
  46. 46.
    Marcus FI, Fontaine GH, Guiraudon G, Frank R, Laurenceau JL, Malergue C, et al. Right ventricular dysplasia: a report of 24 adult cases. Circulation. 1982;65:384–98.CrossRefPubMedGoogle Scholar
  47. 47.
    Corrado D, Thiene G, Nava A, Rossi L, Pennelli N. Sudden death in young competitive athletes: clinicopathologic correlations in 22 cases. Am J Med. 1990;89:588–96.CrossRefPubMedGoogle Scholar
  48. 48.
    Hodes AR, Tichnell C, Te Riele AS, Murray B, Groeneweg JA, Sawant AC, et al. Pregnancy course and outcomes in women with arrhythmogenic right ventricular cardiomyopathy. Heart. 2016;102:303–12.CrossRefPubMedGoogle Scholar
  49. 49.
    Gibson PS, Powrie R, Peipert J. Prevalence of syncope and recurrent presyncope during pregnancy. Obstet Gynecol. 2001;97:S41–2.Google Scholar
  50. 50.
    Muppa P, Sheldon RS, McRae M, Keller NR, Ritchie D, Krahn AD, et al. Gynecological and menstrual disorders in women with vasovagal syncope. Clin Auton Res. 2013;23:117–22.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ciorsti MacIntyre
    • 1
  • Chinyere Iwuala
    • 1
  • Ratika Parkash
    • 1
  1. 1.Department of Medicine, HalifaxQueen Elizabeth II Health Sciences CenterHalifaxCanada

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