Tachyarrhythmias and Pregnancy, a recently published article from the e-journal of the ESC Council for Cardiology Practice has released new insights into managing this debilitating condition. The conclusion of the report, which is available in full on the Escardio website, states that "Prognosis will depend on 1) the type of underlying heart disease and 2) the type of tachycardia, and 3) the degree of hemodynamic compromise of the patient.In cases of absence of structural heart disease, prognosis usually points to a benign condition, responding favorably to antiarrhythmic drugs. Treatment remains a challenge though, as clinical decision must be tackled with appropriate consideration of both maternal and fetal factors. Monitoring both mother and fetus should be continued during acute treatment, and in a stable patient, non-invasive manoeuvres should first be attempted. Evaluation in all cases of the underlying etiology and the degree of left ventricular function (dysfunction) is essential. Correct treatment of arrhythmias in the intensive care patient should be based on understanding the causal mechanism. In pregnant women with maternal and/or fetal arrhythmias, therapeutic strategies should be based on interdisciplinary cooperation (obstetrics, cardiology and neonatology).
In general, acute therapy of arrhythmias during pregnancy is similar to that in the nonpregnant patient. However, special consideration should be given to potential teratogenic and hemodynamic adverse effects on the fetus. With this in mind, a successful pregnancy, for both mother and the fetus, can usually be the result. Optimal evidence-based management of maternal SVT in pregnancy however, particularly in the first trimester, is limited by the paucity of reported cases.
