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Review
. 2022 Jan;8(1):120-135.
doi: 10.1016/j.jacep.2021.10.004. Epub 2021 Dec 22.

Arrhythmias in Pregnancy

Kamala P Tamirisa  1 , Uri Elkayam  2 , Joan E Briller  3 , Pamela K Mason  4 , Jayasree Pillarisetti  5 , Faisal M Merchant  6 , Hena Patel  7 , Dhanunjaya R Lakkireddy  8 , Andrea M Russo  9 , Annabelle Santos Volgman  10 , Marmar Vaseghi  11
Affiliations
Free article
Review

Arrhythmias in Pregnancy

Kamala P Tamirisa et al. JACC Clin Electrophysiol. 2022 Jan.
Free article

Abstract

Increasing maternal mortality and incidence of arrhythmias in pregnancy have been noted over the past 2 decades in the United States. Pregnancy is associated with a greater risk of arrhythmias, and patients with a history of arrhythmias are at significant risk of arrhythmia recurrence during pregnancy. The incidence of atrial fibrillation in pregnancy is rising. This review discusses the management of tachyarrhythmias and bradyarrhythmias in pregnancy, including management of cardiac arrest. Management of fetal arrhythmias are also reviewed. For patients without structural heart disease, β-blocker therapy, especially propranolol and metoprolol, and antiarrhythmic drugs, such as flecainide and sotalol, can be safely used to treat tachyarrhythmias. As a last resort, catheter ablation with minimal fluoroscopy can be performed. Device implantation can be safely performed with minimal fluoroscopy and under echocardiographic or ultrasound guidance in patients with clear indications for devices during pregnancy. Because of rising maternal mortality in the United States, which is partly driven by increasing maternal age and comorbidities, a multidisciplinary and/or integrative approach to arrhythmia management from the prepartum to the postpartum period is needed.

Keywords: arrhythmias; fetal; peripartum; pregnancy.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Vaseghi was supported by NIH R01 HL148190. Dr Mason has been a consultant for Medtronic and Boston Scientific. Dr Russo has received research funding from or has been a member of steering committees for Boston Scientific, Kestra, Medilynx, and Medtronic; and has been a consultant for Atricure, Biosense Webster, and Medtronic. Dr Volgman has been a MSD/Bayer Virtual Global Advisory Board Member; has been a member Bristol Myers Squibb Foundation of the Diverse Clinical Investigator Career Development Program; has been a member of the National Advisory Committee; and holds stock in Apple. Dr Vaseghi holds stock in Secures Inc.

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