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Maternal Arrhythmia: A Case Report and Review of the Literature

Moore, Jessica S. MS*; Teefey, Patrick MD; Rao, Kiran MD; Berlowitz, Michael S. MD, FACC§; Chae, Sanders H. MD; Yankowitz, Jerome MD

Obstetrical & Gynecological Survey: May 2012 - Volume 67 - Issue 5 - p 298–312
doi: 10.1097/OGX.0b013e318253a76e
CME Program: CME Review Article 14
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CME

Pregnant patients with maternal arrhythmias can be challenging and difficult to treat. Medication choices may be limited in patients who are pregnant. Pregnancy carries with it a unique and complex physiology, coupled with fetal concerns. We describe a pregnant patient with an arrhythmia to illustrate treatment thought process and options. We also present a comprehensive review of the literature in regard to treatment of maternal arrhythmias and their potential adverse fetal and maternal outcomes. These treatments include antiarrhythmic medications, electrical cardioversion, and radiofrequency ablation. Antepartum and intrapartum monitoring will also be addressed along with delivery planning and postpartum considerations. The most important aspect in treating these patients is the use of a multidisciplinary approach. The decision of what therapy to use must be addressed on a case-by-case basis with special attention to the patient's individual issues and concerns.

Target Audience: Obstetricians and gynecologists, family physicians, emergency room physicians

Learning Objectives: After completion of this educational activity, the obstetrician/gynecologist should be better able to assess and council patients on the risks and complications of maternal arrhythmias in pregnancy. Evaluate the current treatment options available for health care providers caring for pregnant patients with maternal arrhythmia, and manage the antepartum course, labor, and delivery in these patients.

*Fourth Year Medical Student, College of Medicine, †Resident, Department of Obstetrics and Gynecology, ‡Maternal Fetal Medicine Fellow, Department of Obstetrics and Gynecology, §Assistant Professor of Medicine, Director of USF Coronary Services, Department of Cardiovascular Sciences, ¶Assistant Professor of Medicine, Department of Cardiovascular Sciences, ‖James M. Ingram Professor and Chairman, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL

CHIEF EDITOR'S NOTE: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA PRA Category 1 CreditsTM can be earned in 2012. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

Dr. Yankowitz is a consultant to Novartis Scientific Advisory Committee and his spouse/life partner (if any) has nothing to disclose. The remaining authors, faculty and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity.

The authors have disclosed that the use of Tocainide and E-4031 for the treatment of arrhythmia as discussed in this article has not been approved by the U.S. Food and Drug Administration.

Lippincott CME Institute has identified and resolved all conflicts of interest concerning this educational activity.

Correspondence requests to: Jessica S. Moore, Department of Obstetrics/Gynecology, University of South Florida, 2 Tampa General Circle, STC, 6th Floor, Tampa, FL 33606. E-mail: jmoore@health.usf.edu.

© 2012 Lippincott Williams & Wilkins, Inc.