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Bekiaridou A, Coleman KM, Sharma N, George D, Liu Y, Gianos E, Rosen S, Mieres JH, Mountantonakis SE. Clinical Significance of Supraventricular Tachycardia During Pregnancy in Healthy Women. JACC Clin Electrophysiol 2024; 10:1304-1312. [PMID: 38661600 DOI: 10.1016/j.jacep.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/06/2024] [Accepted: 03/07/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Supraventricular tachycardias (SVT) are the most frequently encountered arrhythmias in pregnancy with unclear clinical significance. OBJECTIVES This study sought to report the prevalence, describe the management, and explore the association between SVT and adverse obstetric outcomes. METHODS Cohort study of primiparous and multiparous women without history of Cesarean section (CS), and with structurally normal hearts admitted in labor. The study group consisted of women with at least 1 SVT episode during pregnancy, and the control group was randomly selected in a 4:1 ratio. RESULTS Of 141,769 women meeting the inclusion criteria, SVT diagnosis was confirmed in 122. A total of 76 (age 33.2 ± 4.8 years) had at least 1 symptomatic and documented episode during pregnancy. In women with a known SVT diagnosis before pregnancy, medical therapy was not associated with a lower risk of SVT recurrence (OR: 1.07; 95% CI: 0.41-2.80). However, catheter ablation before pregnancy was associated with significantly lower risk of SVT recurrence (OR: 0.09; 95% CI: 0.04-0.23). Women with SVT during pregnancy had higher incidence of CS (39.5% vs 27.0%; P = 0.03), and preterm labor (PTL) (30.3% vs 8.6%; P < 0.001). Adjusting for age and parity, SVT during pregnancy was an independent predictor of CS (OR: 1.80; 95% CI: 1.03-3.10), particularly planned CS (OR: 2.89; 95% CI: 1.06-7.89) and PTL (OR: 4.37; 95% CI: 2.30-8.31). CONCLUSIONS SVT during pregnancy is associated with increased risk for CS and PTL in healthy women. History of SVT should be sought as early as preconception counseling, and a multidisciplinary approach is warranted for both prevention and management of SVT occurrence.
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Affiliation(s)
- Alexandra Bekiaridou
- Northwell Health, New Hyde Park, New York, USA; Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, USA; Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Kristie M Coleman
- Northwell Health, New Hyde Park, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA; Lenox Hill Hospital, New York, New York, USA. https://twitter.com/keepinrhythm
| | - Nikhil Sharma
- Northwell Health, New Hyde Park, New York, USA; Feinstein Institute for Medical Research, Manhasset, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA
| | - Deepika George
- Northwell Health, New Hyde Park, New York, USA; Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Yan Liu
- Northwell Health, New Hyde Park, New York, USA; Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Eugenia Gianos
- Northwell Health, New Hyde Park, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA; Lenox Hill Hospital, New York, New York, USA
| | - Stacey Rosen
- Northwell Health, New Hyde Park, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA
| | - Jennifer H Mieres
- Northwell Health, New Hyde Park, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA
| | - Stavros E Mountantonakis
- Northwell Health, New Hyde Park, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA; Lenox Hill Hospital, New York, New York, USA.
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Agarwal A, Murkey SP, Pandit P, Jaiswal A, Agrawal S. Navigating the Complexity: A Comprehensive Review of Managing Pregnancy in Complete Heart Block Cases. Cureus 2023; 15:e50977. [PMID: 38259400 PMCID: PMC10801392 DOI: 10.7759/cureus.50977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
This review explores the comprehensive management of pregnancy in cases of complete heart block, a cardiac condition characterized by the dissociation between atrial and ventricular conduction. The review begins with a thorough examination of preconception counseling, emphasizing the assessment of maternal health, the evaluation of cardiac function, and the identification of potential risks. Subsequently, the medical management section delves into using beta-blockers, pacemakers, and antiarrhythmic drugs to monitor cardiac function during pregnancy and adjust medication regimens. Obstetric considerations highlight the importance of antenatal care, fetal monitoring, and thoughtful delivery planning, including the choice between vaginal delivery and cesarean section. The section on complications underscores the risks of arrhythmias, heart failure, premature birth, and neonatal cardiac issues. Looking ahead, the future directions and research section explores ongoing studies in genetics, pharmacology, and technological innovations, envisioning potential advancements in pacing technology and personalized medicine approaches. The conclusion synthesizes key findings, offering recommendations for clinical practice and reflecting on the challenges and opportunities inherent in managing pregnancy in complete heart block cases. The multidisciplinary approach emerges as paramount, with collaborative efforts paving the way for improved patient outcomes and advancements in the field.
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Affiliation(s)
- Akash Agarwal
- Surgery, Jawaharlal Nehru Medical College, Wardha, IND
| | | | - Pranam Pandit
- Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Arpita Jaiswal
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Wardha, IND
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Joglar JA, Kapa S, Saarel EV, Dubin AM, Gorenek B, Hameed AB, Lara de Melo S, Leal MA, Mondésert B, Pacheco LD, Robinson MR, Sarkozy A, Silversides CK, Spears D, Srinivas SK, Strasburger JF, Tedrow UB, Wright JM, Zelop CM, Zentner D. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm 2023; 20:e175-e264. [PMID: 37211147 DOI: 10.1016/j.hrthm.2023.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
This international multidisciplinary expert consensus statement is intended to provide comprehensive guidance that can be referenced at the point of care to cardiac electrophysiologists, cardiologists, and other health care professionals, on the management of cardiac arrhythmias in pregnant patients and in fetuses. This document covers general concepts related to arrhythmias, including both brady- and tachyarrhythmias, in both the patient and the fetus during pregnancy. Recommendations are provided for optimal approaches to diagnosis and evaluation of arrhythmias; selection of invasive and noninvasive options for treatment of arrhythmias; and disease- and patient-specific considerations when risk stratifying, diagnosing, and treating arrhythmias in pregnant patients and fetuses. Gaps in knowledge and new directions for future research are also identified.
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Affiliation(s)
- José A Joglar
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Elizabeth V Saarel
- St. Luke's Health System, Boise, Idaho, and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | | | - Luis D Pacheco
- The University of Texas Medical Branch at Galveston, Galveston, Texas
| | | | - Andrea Sarkozy
- University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | | | - Danna Spears
- University Health Network, Toronto, Ontario, Canada
| | - Sindhu K Srinivas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Carolyn M Zelop
- The Valley Health System, Ridgewood, New Jersey; New York University Grossman School of Medicine, New York, New York
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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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Safavi-Naeini P, Sorurbakhsh NZ, Razavi M. Cardiac Arrhythmias During Pregnancy. Tex Heart Inst J 2021; 48:472197. [PMID: 34669954 DOI: 10.14503/thij-21-7548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
| | | | - Mehdi Razavi
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Section of Cardiology, Baylor College of Medicine, Houston, Texas
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Chen T, Yang Y, Shi K, Pan Y, Wei S, Yang Z, Yang X. Multiple antiarrhythmic transplacental treatments for fetal supraventricular tachyarrhythmia: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e23534. [PMID: 33327301 PMCID: PMC7738056 DOI: 10.1097/md.0000000000023534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 10/30/2020] [Accepted: 11/06/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Fetal supraventricular tachyarrhythmia is a common reason for referral to fetal cardiology. Multiple antiarrhythmic transplacental medications can be used to treat these diseases. Debates remain regarding the standardized therapy. METHODS PubMed, EMBASE, Cochrane Library, Web of Science, Google Scholar, and ClinicalTrials.gov will be searched from inception to September 2020. A handsearching for gray literature, including unpublished conference articles, will be performed. The randomized control trials, case-control, and cohort studies will be accepted, no matter what the languages they were reported. We will first focus on the effectiveness of the therapy on fetal cardiac rhythm and/or heart rate. Then we will do further analysis of preterm delivery, fetal hydrops, intrauterine fetal demise, and maternal side effects. The Cochrane Risk of Bias Tool and the Newcastle-Ottawa scale will be used to assess the risk of bias of the randomized controlled trials, case-control, and cohort studies, respectively. Two independent reviewers will carry out literature identification, data collection, and study quality assessment. Discrepancies will be resolved by a third reviewer. Statistical analysis will be conducted using the STATA 13.0 software. RESULT The results will provide helpful information about the effect of multiple antiarrhythmic transplacental therapies in pregnancies with supraventricular tachycardia or atrial flutter, and demonstrate which therapy is more effective. CONCLUSION The conclusion drawn from this systematic review will benefit the patients with fetal supraventricular tachyarrhythmia.
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Affiliation(s)
| | | | - Kun Shi
- Department of Pediatric Cardiology
| | | | | | - Zexuan Yang
- Department of Ultrasound, Chengdu Women's and Children’ s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Yuan SM, Xu ZY. Fetal arrhythmias: prenatal evaluation and intrauterine therapeutics. Ital J Pediatr 2020; 46:21. [PMID: 32050988 PMCID: PMC7017517 DOI: 10.1186/s13052-020-0785-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/03/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Fetal arrhythmias are a common phenomenon with rather complicated etiologies. Debates remain regarding prenatal diagnosis and treatment of fetal arrhythmias. Methods The literature reporting on prenatal diagnosis and treatment of fetal arrhythmias published in the recent two decades were retrieved, collected and analyzed. Results Both fetal magnetocardiogram and electrocardiogram provide information of cardiac time intervals, including the QRS and QT durations. M-mode ultrasound detects the AV and VA intervals, fetal heart rate, and AV conduction. By using Doppler ultrasound, simultaneous recording of the atrial and ventricular waves can be obtained. Benign fetal arrhythmias, including premature contractions and sinus tachycardia, do not need any treatment before and after birth. Sustained fetal arrhythmias that predispose to the occurrence of hydrops fetalis, cardiac dysfunction or eventual fetal demise require active treatments. Intrauterine therapy of fetal tachyarrhythmias has been carried out by the transplacental route. If maternal transplacental treatment fails, intraumbilical, intraperitoneal, or direct fetal intramuscular injection of antiarrhythmic agents can be attempted. Conclusions The outcomes of intrauterine therapy of fetal tachyarrhythmias depend on the types or etiology of fetal arrhythmias and fetal conditions. Most are curable to a transplacental treatment by the first-line antiarrhythmic agents. Fetal cardiac pacings are effective methods to restore sinus rhythm in drug-resistant or hemodynamically compromised cases. Immediate postnatal pacemaker implantation is warranted in refractory cases.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, 389 Longdejing Street, Chengxiang District, Putian, 351100, Fujian Province, People's Republic of China
| | - Zhi-Yang Xu
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, 389 Longdejing Street, Chengxiang District, Putian, 351100, Fujian Province, People's Republic of China.
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Pregnancy and newborn outcomes in arrhythmogenic right ventricular cardiomyopathy/dysplasia. Int J Cardiol 2018; 258:172-178. [DOI: 10.1016/j.ijcard.2017.11.067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/03/2017] [Accepted: 11/20/2017] [Indexed: 11/18/2022]
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