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Francinetti A, Vullings R, Dewals W, Jochems L. Pharmacological cardioversion of supraventricular tachycardia in pregnancy during continuous electrophysiological foetal monitoring: a case report. Eur Heart J Case Rep 2022; 6:ytac213. [PMID: 35673277 PMCID: PMC9168670 DOI: 10.1093/ehjcr/ytac213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/10/2022] [Accepted: 05/19/2022] [Indexed: 11/18/2022]
Abstract
Background Maternal tachycardia is the most frequently occurring cardiac complication during pregnancy. Often administration of drugs is required as a treatment. The drug of choice is intravenously administered adenosine because it is considered safe, though there are limited studies regarding safety for the foetus with the use of adenosine. Case summary We report a conversion of maternal atrio-ventricular (AV) nodal reentry tachycardia during pregnancy with the use of intravenous adenosine whilst continuous electrophysiological foetal monitoring. Four seconds after the maternal conversion, the foetal tracing suggests the presence of a ventricular extrasystole or a transient AV block. Discussion This case report illustrates that the administration of adenosine intravenously during pregnancy could have an effect on the foetal conduction system. Therefore, further investigation to assess the electrophysiological effect of adenosine on the foetal electrocardiogram seems required.
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Affiliation(s)
- Audrey Francinetti
- Departement of Gynaecology and Obstetrics UZA, Antwerp University Hospital , Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Rik Vullings
- Signal Processing Systems group, Eindhoven University of Technology , 5612 AZ Eindhoven, Netherlands
| | - Wendy Dewals
- Departement of Pediatric Cardiology UZA, Antwerp University Hospital , Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Lisbeth Jochems
- Departement of Gynaecology and Obstetrics UZA, Antwerp University Hospital , Drie Eikenstraat 655, 2650 Edegem, Belgium
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Ibetoh CN, Stratulat E, Liu F, Wuni GY, Bahuva R, Shafiq MA, Gattas BS, Gordon DK. Supraventricular Tachycardia in Pregnancy: Gestational and Labor Differences in Treatment. Cureus 2021; 13:e18479. [PMID: 34659918 PMCID: PMC8494174 DOI: 10.7759/cureus.18479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022] Open
Abstract
Supraventricular tachycardia (SVT) is a tachyarrhythmia characterized by a heart rate above 120 beats per minute (BPM). Patients with SVT exhibit the following symptoms: palpitations, shortness of breath, chest pain, hemodynamic instability, or possibly asymptomatic. The increase in cardiac output and the increase in resting heart rate during pregnancy predispose pregnant women to SVT. The management of SVT in pregnancy, although remarkably similar, varies slightly based on the trimester of pregnancy. Atenolol and verapamil are effective methods of treating SVT, which can be used during the second and third trimesters. Both medications are contraindicated in the first trimester. At the same time, intravenous adenosine can be used in all three trimesters, including labor. Electrical cardioversion is an effective treatment method for hemodynamically unstable or drug-refractory patients, which has proven to be safe in all three trimesters, including labor but can result in pre-term labor in the third trimester. Non-fluoroscopic ablation proved to be the only treatment method that definitively resolved SVT without recurrence.
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Affiliation(s)
- Crystal N Ibetoh
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Eugeniu Stratulat
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Fan Liu
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - George Y Wuni
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ronak Bahuva
- Internal Medicine, California Institute of Behavioral Neuroscience & Psychology, Fairfield, USA.,Internal Medicine, University at Buffalo, Buffalo, USA
| | - Muhammad A Shafiq
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Internal Medicine, Rawalpindi Medical University, Islamabad, PAK
| | - Boula S Gattas
- Internal Medicine, California Institute of Behavioral Neuroscience & Psychology, Fairfield, USA
| | - Domonick K Gordon
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Internal Medicine, Scarborough General Hospital, Scarborough, TTO
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Sagrillo-Fagundes L, Casagrande Paim T, Pretto L, Bertaco I, Zanatelli C, Vaillancourt C, Wink MR. The implications of the purinergic signaling throughout pregnancy. J Cell Physiol 2021; 237:507-522. [PMID: 34596240 DOI: 10.1002/jcp.30594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/26/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022]
Abstract
Purinergic signaling is a necessary mechanism to trigger or even amplify cell communication. Its ligands, notably adenosine triphosphate (ATP) and adenosine, modulate specific membrane-bound receptors in virtually all human cells. Regardless of the stage of the pregnancy, cellular communication between maternal, placental, and fetal cells is the paramount mechanism to sustain its optimal status. In this review, we describe the crucial role of purinergic signaling on the regulation of the maternal-fetal trophic exchanges, immune control, and endocrine exchanges throughout pregnancy. The nature of the modulation of both ATP and adenosine on the embryo-maternal interface, going through placental invasion until birth delivery depends on the general maternal-fetal health state and consequently on the selective activation of their specific receptors. In addition, an increasing number of studies have been demonstrating the pivotal role of ATP and adenosine in modulating deleterious effects of suboptimal conditions of pregnancy. Here, we discuss the role of purinergic signaling on the balance that coordinates the embryo-maternal exchanges and a promising therapeutic venue in the context of pregnancy disorders.
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Affiliation(s)
- Lucas Sagrillo-Fagundes
- Departamento de Ciências Básicas da Saúde e Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Thaís Casagrande Paim
- Departamento de Ciências Básicas da Saúde e Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luiza Pretto
- Departamento de Ciências Básicas da Saúde e Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Isadora Bertaco
- Departamento de Ciências Básicas da Saúde e Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carla Zanatelli
- Departamento de Ciências Básicas da Saúde e Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cathy Vaillancourt
- Centre Armand Frappier Santé Biotechnologie, INRS, Laval, Quebec, Canada
| | - Márcia R Wink
- Departamento de Ciências Básicas da Saúde e Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Schiff S, Sacchetti A, Santiago J, Beatty L. Lack of fetal effect from adenosine administration in a pregnant patient. Am J Emerg Med 2019; 37:1604.e1-1604.e2. [PMID: 31155170 DOI: 10.1016/j.ajem.2019.05.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/17/2019] [Accepted: 05/22/2019] [Indexed: 11/25/2022] Open
Abstract
Supraventricular Tachycardias are the most common cardiac rhythm disturbances in pregnant patients. Adenosine is the recommended medication to treat these arrhythmias in part because the medication is projected to be metabolized prior to crossing the placenta and producing any fetal effects. Reported here is a case of a pregnant patient treated with adenosine in which the fetal heart activity was monitored through point of care ultrasonography with documentation of no fetal impact from this medication. This is the first documentation of a lack of fetal effect from adenosine.
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Affiliation(s)
- Samuel Schiff
- Our Lady of Lourdes Medical Center, Department of Emergency Medicine, Camden, NJ, United States of America; Thomas Jefferson University, Department of Emergency Medicine, Philadelphia, PA, United States of America
| | - Alfred Sacchetti
- Our Lady of Lourdes Medical Center, Department of Emergency Medicine, Camden, NJ, United States of America; Thomas Jefferson University, Department of Emergency Medicine, Philadelphia, PA, United States of America.
| | - Jillian Santiago
- Our Lady of Lourdes Medical Center, Department of Emergency Medicine, Camden, NJ, United States of America
| | - Lynn Beatty
- Our Lady of Lourdes Medical Center, Department of Emergency Medicine, Camden, NJ, United States of America
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Abstract
The risk of arrhythmia development or recurrence is increased during pregnancy. For those arrhythmias that are unresponsive to conservative therapy, such as vagal maneuvers or life style interventions, or that present a higher risk to the mother or fetus, medical therapy may be necessary. In each case, the patient and provider must carefully consider the risks and benefits of a particular therapy. This requires an understanding of the data regarding the safety and efficacy of any particular drug, which in some cases may be extensive and in others quite limited. Fortunately, options exist for the treatment of arrhythmias during pregnancy.
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Affiliation(s)
- Jennifer M Wright
- a Cardiovascular Division, Department of Medicine , University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
| | - Richard L Page
- a Cardiovascular Division, Department of Medicine , University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
| | - Michael E Field
- a Cardiovascular Division, Department of Medicine , University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
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Hellenkamp K, Weil MB, Aschka C, Vollmann D. Fetal heart rate during termination of maternal supraventricular tachycardia with adenosine. Clin Res Cardiol 2014; 103:413-6. [PMID: 24445752 DOI: 10.1007/s00392-014-0667-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Kristian Hellenkamp
- Clinic for Cardiology and Pneumology/Heart Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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Matsubara S, Kuwata T, Mitsuhashi T. Adenosine for Maternal Supraventricular Tachycardia and Preterm Delivery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:794-795. [DOI: 10.1016/s1701-2163(16)34980-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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