{"id":9256,"date":"2025-11-22T14:12:13","date_gmt":"2025-11-22T11:12:13","guid":{"rendered":"https:\/\/jordan-cardiac.org\/?p=9256"},"modified":"2025-11-22T14:12:13","modified_gmt":"2025-11-22T11:12:13","slug":"management-of-arrhythmias-during-pregnancy-key-points","status":"publish","type":"post","link":"https:\/\/jordan-cardiac.org\/en\/management-of-arrhythmias-during-pregnancy-key-points\/","title":{"rendered":"Management of Arrhythmias During Pregnancy \u2013 Key Points"},"content":{"rendered":"
Management of Arrhythmias During Pregnancy \u2013 Key Points<\/div>\n
<\/div>\n
Source: 2025 ESC Guidelines on CVD in pregnancy, supported by the November 2025 analysis on arrhythmias in pregnancy (J Multidiscip Healthc).<\/div>\n
<\/div>\n
Keynotes:<\/div>\n
\u20071.\u2060 \u2060Importance of the Consensus<\/div>\n
\u2022 Provides the first unified, multidisciplinary approach (EP, OB, neonatology, genetics).<\/span><\/div>\n
\u2022 Summarizes limited evidence into clear, graded recommendations.<\/span><\/div>\n
\u2022 Acts as a practical one-stop reference for managing maternal and fetal arrhythmias.<\/span><\/div>\n
<\/div>\n
\u20072.\u2060 \u2060Most Common Presentation<\/div>\n
\u2022 Palpitations are the most common cardiac symptom in pregnancy.<\/span><\/div>\n
\u2022 Only ~10% show a true arrhythmia on ECG\/monitoring.<\/span><\/div>\n
\u2022 Most detected rhythms are benign (sinus tachycardia, PACs).<\/span><\/div>\n
<\/div>\n
\u20073.\u2060 \u2060Initial Diagnostic Workup<\/div>\n
\u2022 Detailed history and physical exam.<\/span><\/div>\n
\u2022 Resting 12-lead ECG.<\/span><\/div>\n
\u2022 Targeted labs (thyroid, anemia, electrolytes).<\/span><\/div>\n
\u2022 Holter\/event monitor if symptoms are concerning.<\/span><\/div>\n
<\/div>\n
\u20074.\u2060 \u2060Arrhythmias Requiring Intervention<\/div>\n
\u2022 Most frequent: Supraventricular tachycardia (SVT).<\/span><\/div>\n
\u2022 Ventricular tachycardia\/fibrillation and high-grade AV block are rare and linked to pre-existing heart disease.<\/span><\/div>\n
<\/div>\n
\u20075.\u2060 \u2060Atrial Fibrillation (AF) Management<\/div>\n
\u2022 Unstable AF: Cardioversion first line; safe in pregnancy<\/span><\/div>\n
\u2022 Stable AF: First-line therapy =\u00a0 beta-blockers<\/span><\/div>\n
\u00a0 \u00a0 \u00a0\u2022 <\/span>In acute, stable Bp -AF during pregnancy, IV beta-blockers are the first-line option for rapid rate control.\u00a0 (with attention to fetal effects).<\/div>\n
\u2022 Second-line: calcium-channel blockers or digoxin.<\/span><\/div>\n
\u2022 Third-line: ibutilide or flecainide.<\/span><\/div>\n
\u2022 Catheter ablation or amiodarone = last resort (Class IIb).<\/span><\/div>\n
\u2022 Anticoagulation guided by CHA\u2082DS\u2082-VASc; DOACs not recommended in pregnancy.<\/span><\/div>\n
<\/div>\n
Anticoagulation in Pregnancy:<\/div>\n
\u2022 Anticoagulation guided by CHA\u2082DS\u2082-VASc<\/span><\/div>\n
\u2022 DOACs not recommended in pregnancy<\/span><\/div>\n
\u2022 Low-Molecular-Weight Heparin (LMWH), first-line and safest option in pregnancy.<\/span><\/div>\n
\u2022 Unfractionated Heparin (UFH)<\/span><\/div>\n
\u2022\u2060\u00a0 \u2060Used when rapid reversal is needed (near delivery or procedures).<\/div>\n
\u00a0 \u00a0 \u00a0\u2022 <\/span>Warfarin is avoided.<\/div>\n
May be allowed (not preferred) in mechanical valve cases at \u22645 mg\/day, and only in 2nd\/3rd trimester.<\/span><\/div>\n
\u2022 Switch to heparin near delivery.<\/span><\/div>\n
(36\u201337 weeks):<\/div>\n
<\/div>\n
6.\u00a0 VT\/VF defibrillation: sternal-apical (left-sided).<\/div>\n
\u2022 The sternal pad is typically placed on the right upper chest next to the sternum.<\/span><\/div>\n
\u2022 However, it can also be placed on the left side of the sternum if anatomy, access, or pregnancy positioning makes it safer or easier -as long as it remains \u201cupper chest\u201d, parasternal, and not near the breast or abdomen.<\/span><\/div>\n
\u2022 The apical pad goes on the left lateral chest below the nipple\/axilla.<\/span><\/div>\n
\u2022 This positioning creates a diagonal shock pathway across both ventricles.<\/span><\/div>\n
\u2022 AF\/SVT cardioversion: anterior\u2013posterior.<\/span><\/div>\n
\u2022 One pad on the front of the chest directly over the heart (anterior).<\/span><\/div>\n
\u2022 The second pad on the back between the shoulder blades (posterior).<\/span><\/div>\n
\u2022 This delivers a front-to-back shock targeting the atria.<\/span><\/div>\n
\u2022 Avoid pads near the abdomen or breast tissue to ensure the electrical current travels through the heart, not surrounding structures.<\/span><\/div>\n
<\/div>\n
\u20077.\u2060 \u2060Invasive Procedures<\/div>\n
\u2022 Can be performed with low or zero fluoroscopy using 3D mapping.<\/span><\/div>\n
\u2022 Lead apron over abdomen not recommended (increases scatter dose).<\/span><\/div>\n
\u2022 Should be performed only in specialized centers.<\/span><\/div>\n
<\/div>\n
\u20078.\u2060 \u2060Lactation Considerations (Postpartum)<\/div>\n
\u2022 Use with caution: digoxin, propranolol, metoprolol, verapamil.<\/span><\/div>\n
\u2022 Generally acceptable: carvedilol, esmolol, procainamide, diltiazem, flecainide, sotalol.<\/span><\/div>\n
\u2022 Avoid if possible: amiodarone.<\/span><\/div>\n
\u2022 DOACs not recommended during breastfeeding.<\/span><\/div>\n
<\/div>\n
\u20079.\u2060 \u2060Genetic Arrhythmias (LQTS, Brugada, CPVT=Catecholaminergic Polymorphic Ventricular Tachycardia)<\/div>\n
\u2022 Continue beta-blockers (caution with nadolol in breastfeeding).<\/span><\/div>\n
\u2022 Brugada: avoid fever, avoid QT-prolonging drugs.<\/span><\/div>\n
\u2022 CPVT: beta-blockers \u00b1 flecainide; avoid epinephrine; minimize ICD shocks.<\/span><\/div>\n
\u2022 All require EP specialist involvement.<\/span><\/div>\n
<\/div>\n
10.\u2060 \u2060Fetal Arrhythmias<\/div>\n
\u2022 Managed in collaboration with pediatric electrophysiology.<\/span><\/div>\n
\u2022 Maternal systemic antiarrhythmics usually adequate; direct fetal administration rarely needed.<\/span><\/div>\n
\u2022 Fetal echo and rhythm monitoring recommended.<\/span><\/div>\n
\u2022 Ablation\/procedures can be safe with radiation minimization techniques.<\/span><\/div>\n
<\/div>\n
11.\u2060 \u2060Syncope in Pregnancy<\/div>\n
\u2022 Occurs in ~1% of pregnancies; first-trimester syncope linked to worse outcomes.<\/span><\/div>\n
\u2022 Workup: history, exam, ECG, orthostatics, echo, monitoring.<\/span><\/div>\n
\u2022 Loop recorder if recurrent.<\/span><\/div>\n
\u2022 Vasovagal syncope with normal workup requires no further\u00a0 testing.<\/span><\/div>\n
\u2022 Third trimester syncope often due to IVC compression, dehydration, autonomic shifts.<\/span><\/div>\n
<\/div>\n
12.\u2060 \u2060Core Principle<\/div>\n
\u2022 Shared decision-making is central: mother + fetus + multidisciplinary team (OB, EP, anesthesia, neonatology, pediatrics).<\/span><\/div>\n
<\/div>\n
https:\/\/doi.org\/10.2147\/JMDH.S535959?urlappend=%3Futm_source%3Dresearchgate.net%26medium%3Darticle<\/a><\/div>\n
https:\/\/www.escardio.org\/Guidelines\/Clinical-Practice-Guidelines\/Cardiovascular-Disease-in-Pregnancy<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"

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: \u20071.\u2060 \u2060Importance of the Consensus \u2022 Provides the first unified, multidisciplinary approach (EP, OB, neonatology, genetics). \u2022 Summarizes limited evidence into clear, graded recommendations. \u2022 […]<\/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-9256","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9256","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=9256"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9256\/revisions"}],"predecessor-version":[{"id":9257,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/9256\/revisions\/9257"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=9256"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=9256"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=9256"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}