Maternal cardiac arrhythmias during pregnancy

During pregnancy an increased incidence of maternal cardiac arrhythmias is observed. These include a wide spectrum, from clinically irrelevant isolate d premature beats to debilitating supraventricular and ventricular tachycar dias. In principle, management of arrhythmias during pregnancy is similar t o that in non-pregnant patients. However, special consideration should be g iven to foetal age and potential teratogenic and haemodynamic adverse drug effects on the foetus. Therapeutic strategy should be guided by interdiscip linary consulting (i.e. cardiology, obstetrics, neonatology). Diagnostic ev aluation must rule out underlying cardiovascular, pulmonary, endocrine or m etabolic diseases. Additionally, precipitating factors such as excessive ca ffeine and/or alcohol ingestion and cigarette smoking should be avoided. Fo r benign arrhythmias a conservative approach is appropriate. Antiarrhythmic drug selection depends on the specific arrhythmia being treated and the ca rdiac condition of the mother and the foetus. Some antiarrhythmic agents, s uch as propranolol, metoprolol, digoxin and quinidine, have been extensivel y tested during pregnancy and have proven to be safe; they should therefore , whenever possible, be used as firstline. For supraventricular tachycardia , intravenous adenosine may be used to terminate the arrhythmia if vagal ma noeuvres fail. In emergency situations cardioversion may be performed with relative safety. Implantable cardioverter defibrillators as a preventive me asure for life-threatening arrhythmias in pregnant patients do not seem to increase the risk of major complications.