Maternal bradyarrhythmia and pregnancy outcomes: insights into obstetric and neonatal impact from a single-center experience

Aliya Smagulova, B Ainabekova, Zhanar S. Abdrakhmanova, Z H Suleymen, Ayan Suleimenovich Abdrakhmanov

2026

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DOI 10.1093/europace/euag105.980
Data confidence 70 medium
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Abstract

Abstract Background while the management of arrhythmias during pregnancy has been widely studied, the specific effects of bradyarrhythmia on obstetric and neonatal outcomes remain poorly understood. Purpose to assess the impact of bradyarrhythmia on maternal, obstetric, and neonatal outcomes during pregnancy. Methods we evaluated 100 pregnant with arrhythmias. Pregnancy outcomes were compared across types of arrhythmias and management strategies determined by the multidisciplinary Pregnancy heart team: pregnant with atrioventricular (AV) block (n=10, main group) and tachyarrhythmia group (n=90, control group). Results mean maternal age and gestational age at diagnosis were comparable between groups (26.2 ± 3.1 vs. 27.3 ± 4.3 years, p = 0.295; 17.9 ± 2.9 vs. 23.6 ± 4.1 weeks, p = 0.532). According to the modified WHO (mWHO 2.0) classification, all women in the bradyarrhythmia group were assigned to risk class II, whereas in the control group, class I was observed in 36 cases (40%), class II in 46 (51.1%), and class III in 8 (8.9%).High-grade atrioventricular (AV) block was pre-existing in four women (all with a CARPREG II score of 3) and first diagnosed during pregnancy in six.In the main group, the predominant symptoms included dizziness (100%), weakness (100%), syncope (70%), and hypotensive episodes (100%), whereas in the control group, palpitations (68.5%, p < 0.001) and milder hemodynamic disturbances predominated. Due to hemodynamic instability and poor tolerance, pacemaker implantation was performed under echocardiographic guidance using electroanatomical mapping (EnSite Precision) without fluoroscopy. The course of pregnancy was notable for a higher incidence of uterine contractile activity in the main group (30% vs. 2%, p = 0.007), while rates of uterine blood flow impairment (20% vs. 18%, p = 0.520), placental abruption (10% vs. 2%, p = 0.237), and preeclampsia (10% vs. 4%, p = 0.237) were similar between groups. Vaginal delivery predominated in both groups (70% vs. 82%, p = 0.553). Fetal birth weight and 5-minute Apgar scores were comparable (3162.7 ± 443.2 g vs. 3212.3 ± 234.1 g, p = 0.891; 8.7 ± 1.1 vs. 8.7 ± 1.2, p = 0.564). No maternal or fetal mortality occurred. At 12-month follow-up, all pacemaker parameters remained optimal, and no arrhythmia recurrence or device-related complications were observed. Conclusions bradyarrhythmia in pregnancy are associated with a higher incidence of uterine contractile activity compared with tachyarrhythmias; however, both maternal and neonatal outcomes remain favorable when managed appropriately within a multidisciplinary heart team framework.