{"id":9250,"date":"2025-11-22T14:07:42","date_gmt":"2025-11-22T11:07:42","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=9250"},"modified":"2025-11-22T14:08:04","modified_gmt":"2025-11-22T11:08:04","slug":"9250","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/9250\/","title":{"rendered":"Management of rrhythmias During Pregnancy Management of Arrhythmias During Pregnancy \u2013 Key Points"},"content":{"rendered":"
\n
\n
\n
\n

Management of rrhythmias During Pregnancy <\/span><\/p>\n

Management of Arrhythmias During Pregnancy \u2013 Key Points <\/span><\/p>\n<\/div>\n

\n
\n
\n

 <\/p>\n

Source: 2025 ESC Guidelines on CVD in pregnancy, supported by the November 2025 analysis on arrhythmias in pregnancy (J Multidiscip Healthc). <\/span><\/p>\n

Keynotes:
\n1. Importance of the Consensus
\n\u2022 Provides the first unified, multidisciplinary approach (EP, OB, neonatology, genetics). \u2022 Summarizes limited evidence into clear, graded recommendations.
\n\u2022 Acts as a practical one-stop reference for managing maternal and fetal arrhythmias. <\/span><\/p>\n

2. Most Common Presentation
\n\u2022 Palpitations are the most common cardiac symptom in pregnancy. \u2022 Only ~10% show a true arrhythmia on ECG\/monitoring.
\n\u2022 Most detected rhythms are benign (sinus tachycardia, PACs). <\/span><\/p>\n

3. Initial Diagnostic Workup
\n\u2022 Detailed history and physical exam.
\n\u2022 Resting 12-lead ECG.
\n\u2022 Targeted labs (thyroid, anemia, electrolytes).
\n\u2022 Holter\/event monitor if symptoms are concerning. <\/span><\/p>\n

4. Arrhythmias Requiring Intervention
\n\u2022 Most frequent: Supraventricular tachycardia (SVT).
\n\u2022 Ventricular tachycardia\/fibrillation and high-grade AV block are rare. <\/span><\/p>\n

5. Atrial Fibrillation (AF) Management
\n\u2022 Unstable AF: Cardioversion first line; safe in pregnancy.
\n\u2022 Stable AF: First-line = beta-blockers (IV for rapid control if needed).<\/span><\/p>\n<\/div>\n

\n
\n
\n

Second-line: calcium-channel blockers or digoxin.
\n\u2022 Third-line: ibutilide or flecainide.
\n\u2022 Ablation\/amiodarone = last resort (Class IIb).
\n\u2022 Anticoagulation guided by CHA2DS2-VASc; DOACs not recommended.<\/span><\/p>\n<\/div>\n

 <\/p>\n

\n

Anticoagulation in Pregnancy: <\/span><\/p>\n

\u2022 LMWH = first-line. <\/span><\/p>\n

\u2022 UFH when rapid reversal needed. <\/span><\/p>\n

\u2022 Warfarin avoided; may be allowed only in specific mechanical valve cases (<\/span>\u2264<\/span>5 mg\/day) in 2nd\/3rd trimester. <\/span><\/p>\n

\u2022 Switch to heparin near delivery (36\u201337 weeks). <\/span><\/p>\n

6. Electrode Pad Placement
\n\u2022 VT\/VF: sternal\u2013apical (left-sided).
\n\u2022 AF\/SVT: anterior\u2013posterior.
\n\u2022 Avoid pads near abdomen\/breast tissue. <\/span><\/p>\n

7. Invasive Procedures
\n\u2022 Low\/zero fluoroscopy with 3D mapping.
\n\u2022 Lead apron over abdomen not recommended. \u2022 Only in specialized centers. <\/span><\/p>\n

8. Lactation Considerations
\n\u2022 Use caution: digoxin, propranolol, metoprolol, verapamil.
\n\u2022 Acceptable: carvedilol, esmolol, procainamide, diltiazem, flecainide, sotalol. \u2022 Avoid: amiodarone.
\n\u2022 DOACs not recommended in breastfeeding.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

\n
\n
\n

9. Genetic Arrhythmias (LQTS, Brugada, CPVT)
\n\u2022 Continue beta-blockers (caution with nadolol).
\n\u2022 Brugada: avoid fever\/QT-prolonging drugs.
\n\u2022 CPVT: beta-blockers \u00b1 flecainide; avoid epinephrine; minimize ICD shocks. <\/span><\/p>\n

10. Fetal Arrhythmias
\n\u2022 Managed with pediatric electrophysiology.
\n\u2022 Maternal systemic therapy usually adequate. \u2022 Fetal echo and monitoring recommended. <\/span><\/p>\n

11. Syncope in Pregnancy
\n\u2022 Occurs in ~1%.
\n\u2022 Workup: exam, ECG, orthostatics, echo, monitoring.
\n\u2022 Loop recorder if recurrent.
\n\u2022 Vasovagal with normal workup needs no further testing. <\/span><\/p>\n

12. Core Principle
\n\u2022 Shared decision-making (OB, EP, anesthesia, neonatology, pediatrics). <\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Management of rrhythmias During Pregnancy Management of Arrhythmias During Pregnancy \u2013 Key Points   Source: 2025 ESC Guidelines on CVD in pregnancy, supported by the November 2025 analysis on arrhythmias in pregnancy (J Multidiscip Healthc). Keynotes: 1. Importance of the Consensus \u2022 Provides the first unified, multidisciplinary approach (EP, OB, neonatology, genetics). \u2022 Summarizes limited […]<\/p>\n","protected":false},"author":145,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9250","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9250","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/145"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=9250"}],"version-history":[{"count":2,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9250\/revisions"}],"predecessor-version":[{"id":9252,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9250\/revisions\/9252"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=9250"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=9250"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=9250"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}