Cardiac arrhythmias during pregnancy

Atrial premature beats are frequently diagnosed during pregnancy (PR), supr aventricular tachycardia (SVT; atrial tachycardia, AV nodal reentrant tachy cardia, circus movement tachycardia) less frequently. For acute therapy, el ectrical cardioversion with 50 - 100 J is indicated in all unstable patient s (pts). In stable SVT the initial therapy includes the vagal maneuver to t erminate breakthrough tachycardias. For short-term management, when the vag al maneuver fails, intravenous adenosine is the first-choice drug and may s afely terminate the arrhythmia. For long-term therapy, beta -blocking agent s with beta (1) selectivity are first-line drugs; class Ic agents or the cl ass III drug sotalol (sot) are effective and therapeutic alternatives. Vent ricular premature beats are also frequently present during PR and benign in most pts; however, malignant ventricular tachyarrhythmias (sustained ventr icular tachycardia [VT], ventricular flutter [VFlut], ventricular fibrillat ion [VF]) were observed less frequently. Electrical cardioversion is necess ary in all pts with a hemodynamically unstable situation and life-threateni ng ventricular tachyarrhythmias; in hemodynamically stable pts, initial the rapy with ajmaline, procainamide or lidocaine is indicated. If prophylactic therapy is needed, beta -blocking agents with beta (1) selectivity are con sidered as first-choice drugs. If this therapy is ineffective, class Ic age nts or sot can be considered. In pts with syncopal VT, VF, VFlut or aborted sudden death an implantable cardioverter-defibrillator is indicated. In pt s with symptomatic bradycardia, a pacemaker can be implanted using echocard iography at any stage of PR. The treatment of the pregnant patient with car diac arrhythmias requires important modification of the standard practice o f arrhythmia management. The goal of therapy is to protect the patient and fetus through delivery, after which chronic or definitive therapy can be ad ministered.