To discuss the diagnosis and management of maternal arrhythmias occurring during pregnancy.
When necessary, current technology allows implantation of arrhythmia management devices and performing catheter ablation procedures with little or no risk from radiation exposure to the fetus.
A variety of cardiac rhythm disturbances can occur during pregnancy, ranging from benign ectopy to life-threatening arrhythmias. In patients with normal hearts and minimally symptomatic arrhythmias, only reassurance is necessary. The quality of the data on managing more serious arrhythmias in pregnancy is somewhat limited, yet with a clear understanding of the maternal hemodynamic changes associated with pregnancy, and the appropriate antiarrhythmic therapies available, almost all cases can be treated successfully. The decision to treat should be based on careful consideration of risk and benefits, yet, when therapy is deemed necessary, it should be administered promptly and with confidence. Drug therapy should be avoided during the first trimester if possible and drugs with the longest record of safety are preferred. The decision to pursue an invasive strategy is complicated by the potential for procedural risks. Yet, the state of modern technology is such that invasive strategies, when justified, can be carried out effectively.
aThe University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
bThe University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin USA
Correspondence to Jose A. Joglar, MD, Professor of Internal Medicine, Program Director, Clinical Cardiac Electrophysiology, Elizabeth Thaxton Page and Ellis Batten Page Professorship in Clinical Cardiac Electrophysiology Research, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas 75390-8837, USA. Tel: +1 214 590 5028; fax: +1 214 590 0402; e-mail: Jose.Joglar@UTSouthwestern.edu