Abstract
Cardiac arrhythmias that occur during pregnancy represent a unique problem, since two lives may be in jeopardy. Most arrhythmias originate in the mother, but occasionally fetal arrhythmias require therapy through maternal administration of drugs. When considering therapeutic interventions, pro-arrhythmia and other adverse effects to both the mother and fetus must be considered. There are also unique risks to the fetus, such as congenital malformations.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Cox JL, Gardner MJ. Treatment of cardiac arrhythmias during pregnancy. Prog Cardiovasc Dis 1993; 36: 137–178.
Metcalfe J, Ueland K. Maternal cardiovascular adjustments to pregnancy. Prog Cardiovasc Dis 1974; 16: 363–374.
Dunlop W. Serial changes in renal hemodynamics during normal human pregnancy. Br J Obstet Gynaecol 1981; 88: 1–9.
Mitani R, Steinberg I, Lien E, Harrison E, Elkayam U. The pharmacokinetics of antiarrhythmic agents in pregnancy and lactation. Clin Pharmacokinet 1987; 12: 253–291.
Widerhorn J, Widerhorn AL, Rahimtoola SH, Elkayam U. WPW syndrome during pregnancy: increased incidence of supraventricular arrhythmias. Am Heart J 1992; 123: 796–798.
Shotan A, Ostrzega E, Mehra A, Johnson JV, Elkayam U. Incidence of arrhythmias in normal pregnancy and relation to palpitations, dizziness, and syncope. Am J Cardiol 1997; 79: 1061–1064.
Brodsky M, Doria R, Allen B, Sato D, Thomas G, Sada M. New-onset ventricular tachycardia during pregnancy. Am Heart J 1992; 123: 933–941.
Perloff J. Pregnancy and congenital heart disease. J Am Coll Cardiol 1991; 18: 340–342.
Lee W, Cotton D. Peripartum cardiomyopathy: current concepts and clinical management. Clin Obstet Gynecol 1989; 32: 54–67.
Vaughan Williams EM. A classification of antiarrhythmic actions reassessed after a decade of new drugs. J Clin Pharmacol 1984; 24: 129–147.
Meyer J, Lackner J, Schochet S. Paroxysmal tachycardia in pregnancy. Am HeartJ 1931; 94: 1901–1904.
Hill L, Malkasian G. The use of quinidine sulfate throughout pregnancy. Obstet Gynecol 1979;54:366– 368.
Wladimiroff J, Stewart A. Treatment of fetal cardiac arrhythmias. Br J Hosp Med 1985; 34: 134–140.
Wong R, Murthy A, Mathisen G, Glover N, Thornton P. Treatment of severe falciparum malaria during pregnancy with quinidine and exchange transfusions. Am J Med 1992; 92: 561–562.
Rotmensh H, Elkayam U, Frishman W. Antiarrhythmic drug therapy during pregnancy. Ann Intern Med 1983; 98: 487–497.
Allen NM, Page RL. Procainamide administration during pregnancy. Clin Pharmacol 1993; 12: 58–60.
Page RL. Treatment of arrhythmias during pregnancy. Am Heart J 1995; 130: 871–876.
Schnider S. Choice of anesthesia for labor and delivery. Obstet Gynecol 1981; 58: 24s–34s.
Martin L, Jurand A. The absence of teratogenic effects of some analgesics use in anesthesia: additional evidence from a mouse model. Anaesthesia 1992; 47: 473–476.
Kim W, Pomerance J. Miller A. Lidocaine intoxication in a newborn following local anesthesia for episiotomy. Pediatrics 1979; 64: 643–645.
Brown W, Bell G, Alper M. Acidosis, local anesthesia and the newborn. Obstet Gynecol 1976; 48: 27–30.
Gregg A, Tomich P. Mexiletine use in pregnancy. J Perinatol 1988; 8: 33–35.
Timmis A, Jackson G, Holt D. Mexiletine for control of ventricular dysrrhythmias during pregnancy. Lancet 1980; 2: 647–648.
Lowes H, Ives T. Mexiletine use in pregnancy and lactation. Am J Obstet Gynecol 1987; 157: 446–447.
Atkinson AJ, Davison R. Diphenylhydantoin as an antiarrhythmic drug. Ann Rev Med 1974; 25: 99–113.
Hanson J, Myrianthopoulos N, Sedwick M, Smith D. Risk to the offspring of women treated with hydantoin anticonvulsants, with emphasis on the fetal hydantoin syndrome. J Pediatr 1976; 89: 662–668.
Echt D, Liebson P, Mitchel B, Peters R, Obias-Manno D, Barker A, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. N Engl J Med 1991; 324: 781–788.
Wagner X, Jouglard J, Moulin M, Miller AM, Petitjean J, Pisapia A. Coadministration of flecainide acetate and sotalol during pregnancy: lack of teratogenic effects, passage across the placenta, and excretion in human breast milk. Am Heart J 1990; 119: 700–702.
Ahmed K, Issawi I, Peddireddy R. Use of flecainide for refractory atrial tachycardia of pregnancy. Am J Crit Care 1996; 5: 306–308.
Allan L, Chita S, Sharland G, Maxwell D, Priestley K. Flecainide in the treatment of fetal tachycardias. Br Heart J 1991; 65: 46–48.
Frohn-Mulder IM, Stewart PA, Witsenburg M, Den Hollander NS, Wladimiroff JW, Hess J. The efficacy of flecainide versus digoxin in the management of fetal supraventricular tachycardia. Prenatal Diagn 1995; 15: 1297–1302.
Simpson J, Sharland G. Fetal tachycardias: management and outcome of 127 consecutive cases. Heart 1998; 79: 576–581.
Vanderhal A, Cocjin J, Santulli T, Carlson D, Rosenthal P. Conjugated hyperbilirubinemia in a newborn infant after maternal (transplacental) treatment with flecainide acetate for fetal tachycardia and fetal hydrops. J Pediatr 1995; 126: 988–990.
Capucci A, Boriani G. Propafenone in the treatment of cardiac arrhythmias. A risk-benefit appraisal. Drug Saf 1995; 12: 55–72.
Frishman W, Chesner M. Beta-adrenergic blockers in pregnancy. Am Heart J 1988; 115: 147–152.
Joglar JA, Page RL. Treatment of cardiac arrhythmias during pregnancy: safety considerations. Drug Saf 1999; 20: 85–94.
Pryun S, Phelan J, Buchanan G. Long-term propanolol therapy in pregnancy: maternal and fetal outcome. Am J Obstet Gynecol 1979; 135: 485–489.
Rubin P, Butters L, Clark D. Placebo-controlled trial of atenolol in treatment of pregnancy-associated hypertension. Lancet 1983; 2: 431–434.
Wichman K, Ryulden G, Karberg B. A placebo controlled trial of metoprolol in the treatment of hypertension in pregnancy. Scand J Clin Lab Investig 1984; 169: 90–94.
Lip G, Beevers M, Churchill D, Shaffer L, Beevers D. Effect of atenolol on birth weight. Am J Cardiol 1997; 79: 1436–1438.
Liedholm H, Melander A, Bitzen P-O, Lonnerholm G, Mattiasson I, Nilsson B, et al. Accumulation of atenolol and metoprolol in human breast milk. Eur J Clin Pharmacol 1981; 20: 229–231.
Delvin R, Duchin K, Fleiss P. Nadolol in human serum and breast milk. Br J Clin Pharmacol 1981; 12: 393–396.
Schmimmel M, Eldelman A, Wilschanski M, Shaw D, Oglivie R, Koren G. Toxic effects of atenolol consumed during breast feeding. J Pediatr 1989; 114: 476–478.
Widerhorn J, Bhandari AK, Bughi S, Rahimtoola SH, Elkayam U. Fetal and neonatal adverse effects profile of amiodarone treatment during pregnancy. Am Heart J 1991; 122: 1162–1166.
Wolf DD, Shepper JD, Verhaaren H, Deneyer M, Smitz J, Sacre-Smits L. Congenital hypothyroid goiter and amiodarone. Acta Paediatr Scand 1988; 77: 616–618.
Magee LA, Downar E, Sermer M, Boulton BC, Allen LC, Koren G. Pregnancy outcome after gestational exposure to amiodarone in Canada. Am J Obstet Gynecol 1995; 172: 1307–1311.
Ovadia M, Brito M, Hoyer G, Marcus F. Human experience with amiodarone in the embrionic period. Am J Cardiol 1994; 73: 316–317.
Strunge P, Frandsen J, Andreasen F. Amiodarone during pregnancy. Eur Heart J 1988; 9: 106–109.
O’Hare M, Murnaghan G, Russell C, Leahey W, Varma M. Sotalol as hypotensive agent in pregnancy. Br J Obstet Gynaecol 1980; 87: 814–820.
Kowey P, VanderLugt J, Luderer J. Safety and risk/benefit analysis of ibutilide for acute conversion of atrial fibrillation/flutter. Am J Cardiol 1996; 78: 46–52.
Klein V, Repke J. Supraventricular tachycardia in pregnancy: cardioversion with verapamil. Obstet Gynecol 1984; 63: 16S–18S.
Byerly WG, Hartmann A, Foster DE, Tannenbaum AK. Verapamil in the treatment of maternal paroxysmal supraventricular tachycardia. Ann Emerg Med 1991; 20: 552–554.
Orlandi C, Marlettini M, Cassani A, Trabatti M, Agostini D, Salomone T, et al. Treatment of hypertension during pregnancy with the calcium channel antagonist verapamil. Curr Ther Res 1986; 39: 884–893.
Kleinman C, Copel J, Weinstein E, Santulli T, Hobbins J. Treatment of fetal supraventricular tachyarrhythmias. J Clin Ultrasound 1985; 13: 265–273.
Camm A, Garrat C. Adenosine and supraventricular tachycardia. N Engl J Med 1991; 325: 1621–1629.
Elkayam U, Goodwin TM. Adenosine therapy for supraventricular tachycardia during pregnancy. Am J Cardiol 1995; 75: 521–523.
Jaqueti J, Martinez-Hernandez D, Hernandez-Garcia R, Navarro-Gallar F. Adenosine deaminase in pregnancy serum. Clin Chem 1990; 36: 2144.
Mason B, Ogjunyemi D, Punla O, Koos B. Maternal and fetal cardiorespiratory responses to adenosine in sheep. Am J Obstet Gynecol 1993; 168: 1558–1561.
Page R. Arrhythmias during pregnancy. Cardiac Electrophysiology Review 1997; I278–I282.
Chen V, Tse T, Wong V. Transfer of digoxin across the placenta and into breast milk. Br J Obstet Gynaecol 1978; 55: 605–609.
Rogers M, Willerson J, Goldblatt A, Smith T. Serum digoxin concentrations in the human fetus, neonate and infant. N Engl J Med 1972; 287: 1010–1013.
Kerenyi T, Gleicher N, Meller J, Brown E, Stenfeld L, Chitkara U, et al. Transplacental cardioversion of intrauterine supraventricular tachycardia with digitalis. Lancet 1980; 2: 393–395.
King C, Mattioli L, Goertz K, Snodgrass W. Successful treatment of fetal supraventricular tachycardia with maternal digoxin therapy. Chest 1984; 85: 573–575.
Parilla BV, Strasburger JF, Socol ML. Fetal supraventricular tachycardia complicated by hydrops fetalis: a role for direct fetal intramuscular therapy. Am J Perinatol 1996; 13: 483–486.
Gonzalez A, Phelps S, Cochran E, Sibai B. Digitalis-like immunoreactive substance in pregnancy. Am J Obstet Gynecol 1987; 157: 660–664.
Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137– 150.
McAnulty J, Morton M, Ueland K. The heart and pregnancy. Curr Probl Cardiol 1988; 13: 589–665.
Dalvi BV, Chaudhuri A, Kulkarni HL, Kale PA. Therapeutic guidelines for congenital complete heart block presenting in pregnancy. Obstet Gynecol 1992; 79: 802–804.
Antonelli D, Bloch L, Rosenfeld T. Implantation of a permanent dual chamber pacemaker in a pregnant woman by transesophageal echocardiographic guidance. PACE 1999; 22: 534–535.
Guldal M, Kervancioglu C, Oral D, Gurel T, Erol C, Sorrel A. Permanent pacemaker implantation in a pregnant woman with the guidance of ECG and two-dimensional echocardiography. PACE 1987; 10: 543–545.
Jordaens LJ, Vandenbogaerde JF, Van de Bruaene P, Du Buyzere M. Transesophageal echocardiography for insertion of a physiological pacemaker in early pregnancy. PACE 1990; 13: 955–957.
Metcalfe J, McAnulty J, Ueland K. Burwell and Metcalfe’s Heart Disease and Pregnancy: Physiology and Management. Little, Brown and Co., Boston, MA, 1986, p. 58.
Mechem CC, Knopp RK, Feldman D. Painless abruptio placentae associated with disseminated intra-vascular coagulation and syncope. Ann Emerg Med 1992; 21: 883–885.
Kniseley RM. Acute internal bleeding as a cause of syncope. American Family Physician 1995; 52: 1278.
Peleg D, Orvieto R, Ferber A, Ben-Rafael Z. Maternal supraventricular tachycardia recorded as apparent fetal heart rate in a case of fetal demise. Acta Obstet Gynecol Scand 1998; 77: 786–787.
Dominguez A, Iturralde P, Hermosillo AG, Colin L, Kershenovich S, Garrido LM. Successful radiofrequency ablation in an accessory pathway during pregnancy. PACE 1999; 22: 131–134.
Ueland K. Rheumatic heart disease and pregnancy. In: Elkayam U, Gleicher N, eds. Cardiac Problems in Pregnancy. Alan R. Liss, New York, NY, 1990, pp. 99–107.
Szekely P, Snaith L. Atrial fibrillation and pregnancy. Br Med J 1961; 1: 1407–1410.
Mendelson C. Disorders of the heart beat during pregnancy. Am J Obstet Gynecol 1956; 72: 1268–1301.
Hall J, Paul R, Wilson K. Maternal and fetal sequelae of anticoagulation during pregnancy. Am J Med 1980; 68: 122–140.
Dahlman T, Lindvall N, Hellgren M. Osteopenia in pregnancy during long-term heparin treatment: a radiological study post-partum. Br J Obstet Gynaecol 1990; 97: 221–228.
Ginsberg J, Hirsh J. Use of antithrombotic agents during pregnancy. Chest 1998; 114: 524s–530s.
Nelson-Piercy C, Letsky EA, de Swiet M. Low-molecular-weight heparin for obstetric thromboprophylaxis: experience of sixty-nine pregnancies in sixty-one women at high risk. Am J Obstet Gynecol 1997; 176: 1062–1068.
Dizzon-Townson D, Branch D. Anticoagulation treatment during pregnancy: an update. Semin Thromb Hemost 1998; 24: 55–63.
Rashba EJ, Zareba W, Moss AJ, Hall WJ, Robinson J, Locati EH, et al. Influence of pregnancy on the risk for cardiac events in patients with hereditary long QT syndrome. LQTS Investigators. Circulation 1998; 97: 451–456.
Rosemond R. Cardioversion during pregnancy. JAMA 1993; 269: 3167.
Natale A, Davidson T, Geiger MJ, Newby K. Implantable cardioverter-defibrillators and pregnancy: a safe combination? Circulation 1997; 96: 2808–2812.
Kloeck W, Cummins RO, Chamberlain D, Bossaert L, Callanan V, Carli P, et al. Special resuscitation situations: an advisory statement from the International Liaison Committee on Resuscitation. Circulation 1997; 95: 2196–2210.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2002 Springer Science+Business Media New York
About this chapter
Cite this chapter
Joglar, J.A., Page, R.L. (2002). Arrhythmias During Pregnancy. In: Ganz, L.I. (eds) Management of Cardiac Arrhythmias. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-090-2_21
Download citation
DOI: https://doi.org/10.1007/978-1-59259-090-2_21
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-61737-218-6
Online ISBN: 978-1-59259-090-2
eBook Packages: Springer Book Archive