Of all the cardiac complications that can occur during pregnancy, arrhythmias are the most common. They can occur in women with and without structural heart disease. Supraventricular and atrial tachycardias are much more common in women of childbearing age compared to ventricular tachycardias. Bradyarrhythmias will not be discussed in this section.
Arrhythmias may present for the first time during pregnancy or pregnancy can trigger arrhythmias in women with a preexisting history of arrhythmias. (1,2) Pregnant women with symptoms suggestive of arrhythmia may present with a variety of complaints, including palpitations, dizziness, presyncope, syncope, chest discomfort, heart failure or fatigue. Palpitations during pregnancy are often not associated with arrhythmias and can be due to sinus tachycardia, sinus arrhythmia or ectopic beats.
Paroxysmal supraventricular tachycardia (PSVT) are the most common arrhythmias detected during pregnancy. PSVT is usually secondary to reentry within the atrioventricular node or through an accessory pathway (overt or concealed). In women without heart disease atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia, followed by atrioventricular reciprocating tachycardia (AVRT).
Atrial fibrillation and flutter during pregnancy are less common than PSVT. They most commonly occur in women with structural heart disease such as rheumatic heart disease, valvular heart disease, cardiomyopathy or congenital heart disease. They can occur in women with structurally normal hearts. Metabolic disturbances such as hyperthyroidism and electrolyte imbalances can also contribute to the development of atrial fibrillation during pregnancy. Women with rheumatic heart disease or congenital lesions may have significant hemodynamic consequences if they develop atrial fibrillation or flutter. Pregnant women with atrial fibrillation are at increased risk of systemic embolism.
Ventricular tachycardia (VT) is rare during pregnancy. It can occur in women with structurally normal heart, but is usually associated with structural heart disease (e.g., congenital heart disease, valvular disease, peripartum cardiomyopathy, hypertrophic cardiomyopathy, coronary artery disease). Other conditions which may contribute to VT are hypomagnesemia, hypertension, thyrotoxicosis and long QT syndrome. Idiopathic VT during pregnancy usually originates from the right ventricular outflow tract and it rarely is associated with unstable rhythm. It has a good prognosis.
Rarely, pregnant women have an implantable cardioverter defibrillator (ICD). Pregnancy is not associated with increased number of shocks, ICD-related complications or adverse fetal events.
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