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Multicenter Study
. 2023 Sep;130(10):1269-1274.
doi: 10.1111/1471-0528.17457. Epub 2023 Apr 11.

Direct current cardioversion in pregnancy: a multicentre study

Matthew Cauldwell  1 , Dawn Adamson  2 , Kaliash Bhatia  3 , Catriona Bhagra  4 , Aidan Bolger  5 , Thomas Everett  6 , Caroline Fox  7 , Joanna Girling  8 , Catherine Head  9 , Kate English  10 , Lucy Hudsmith  11 , Rachael James  12 , Mark Johnson  13 , Lucy MacKiliop  14   15 , Fionnuala M McAuliffe  16 , Gayathri Mariappa  8 , Elizabeth Orchard  17 , Maggy O'Brien  16 , Farah Siddiqui  18 , Lydia Simpson  19 , Maggie Simpson  20 , Paul Timmons  21 , Sarah Vause  22 , Gurleen Wander  13 , Niki Walker  20 , Philip J Steer  13
Affiliations
Multicenter Study

Direct current cardioversion in pregnancy: a multicentre study

Matthew Cauldwell et al. BJOG. 2023 Sep.

Abstract

Objective: Direct current cardioversion (DCCV) in pregnancy is rarely required and typically only documented in single case reports or case series. A recent UK confidential enquiry reported on several maternal deaths where appropriate DCCV appeared to have been withheld.

Design: Retrospective cohort study.

Setting: Seventeen UK and Ireland specialist maternity centres.

Sample: Twenty-seven pregnant women requiring DCCV in pregnancy.

Main outcome measures: Maternal and fetal outcomes following DCCV.

Results: Twenty-seven women had a total of 29 DCCVs in pregnancy. Of these, 19 (70%) initial presentations were to Emergency Departments and eight (30%) to maternity settings. There were no maternal deaths. Seventeen of the women (63%) had a prior history of heart disease. Median gestation at DCCV was 28 weeks, median gestation at delivery was 35 weeks, with a live birth in all cases. The abnormal heart rhythms documented at the first cardioversion were atrial fibrillation in 12/27 (44%) cases, atrial flutter in 8/27 (30%), supraventricular tachycardia in 5/27 (19%) and atrial tachycardia in 2/27 (7%). Fetal monitoring was undertaken following DCCV on 14/29 (48%) occasions (10 of 19 (53%) at ≥26 weeks) and on 2/29 (7%) occasions, urgent delivery was required post DCCV.

Conclusions: Direct current cardioversion in pregnancy is rarely required but should be undertaken when clinically indicated according to standard algorithms to optimise maternal wellbeing. Once the woman is stable post DCCV, gestation-relevant fetal monitoring should be undertaken. Maternity units should develop multidisciplinary processes to ensure pregnant women receive the same standard of care as their non-pregnant counterparts.

Keywords: arrhythmia; atrial fibrillation; atrial flutter; cardioversion; heart disease; maternal; morbidity; tachycardia.

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References

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