Arrhythmia in pregnant women: what management is better?

Ayan Suleimenovich Abdrakhmanov, Bayan A. Ainabekova, O Nuralinov, Abay Bakytzhanuly, Aliya Smagulova

2022

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DOI 10.1093/eurheartj/ehac544.445
Data confidence 70 medium
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Abstract

Abstract Background Arrhythmias in pregnant women are commonly seen but have not been extensively studied. Drug therapy or catheter ablation during pregnancy may be required in cases of maternal arrhythmias. However, the studies did not examine the outcomes of pregnancy in cases with different management of arrhythmias. Objective We aimed to determine if there are any differences in pregnancy outcomes in women with disparate types of arrhythmia treatment. Methods We conducted a prospective study of all pregnant patients who were admitted to our hospital with arrhythmias from 2017–2020. For patients with benign arrhythmias drug therapy was not required (n=11; 14.5%, 1st group). Antiarrhythmic treatment was justified in cases with frequent symptoms and haemodynamic instability (n=65; 85.5%). Patients with effective antiarrhythmic therapy were included in 2nd group (n=31; 40.8%). In patients with drug refractory and dangerous rhythm disturbances (n=34; 44.7%, 3d group) were performed zero-fluoroscopy catheter ablation. Results A total of 76 pregnant women were admitted with arrhythmias. Mean age was 27.24±5.15 years, mean gestation age 21.27±5.34 weeks. Supraventricular tachycardia was the most common arrhythmias (n=41; 53.9%) This was followed by premature contractions (n=27; 35.6%) and ventricular tachycardia (n=8; 10.5%). There was significant difference in frequency of performed catheter ablation for disparate types of arrhythmia: 70.7% for cases of supraventricular tachycardia, 25% - ventricular tachycardia and 11.1% - premature contractions (p=0.000). Ablations were effective in all cases without adverse outcome. All ablations were performed without fluoroscopy. Vaginal delivery was in the majority in all groups (75.6% vs 62.5% vs 74.1%, p=0.736). Similarly, no differences were noted in obstetric complication (14.6% vs 12.5% vs 18.5%, p=0.656). None of them had fetal mortality. Conclusions Some patients with arrhythmias needed catheter ablation during pregnancy. There was no significant difference in type of delivery and neonatal outcomes in women with separate management of arrhythmias. Funding Acknowledgement Type of funding sources: None.