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Idiopathic ventricular tachycardia. Monomorphic ventricular tachycardia in a 34-year-old pregnant woman with syncope and a structurally normal heart. There are frequent ventricular ectopic beats with a left bundle branch block (LBBB) morphology and a QRS axis of around +100˚, indicating a right ventricular outflow tract origin. The patient was successfully treated with b-blockers during pregnancy and had a successful ablation after delivery.
Context in source publication
Context 1
... right ventricular tachycardia (VT) originating from the right ventricular outflow tract just below the pulmonary valve is the most common form of idiopathic VT seen in pregnancy (fig 3). It virtually never accelerates to an unstable rhythm and patients most commonly experience ectopic beats, bigemini or short runs of non-sustained VT. ...
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We report a case of a 42-year-old Caucasian man who presented with isolated right ventricular failure and atrial fibrillation without ventricular arrhythmia. In this report, we describe accurate evaluation by MR imaging confirmed by histopathologic findings as well as imaging progression of this unusual case of arrhythmogenic right ventricular dysp...
Citations
... Unfortunately, there are currently no specific and reliable predictors to determine whether myocardial recovery will occur. One of the factors contributing to the development of PPCM appears to be inflammation [30][31][32][33]. The link between inflammation and stress is very important and could be a good avenue to explore with future research. ...
... Endothelial dysfunction is characterized by reduced production of nitric oxide, a potent vasodilator. Impaired endothelial function contributes to vasoconstriction, inflammation, and thrombosis, further exacerbating cardiovascular risk [30][31][32][33][34]. ...
The prevention of cardiovascular diseases is a fundamental pillar for reducing morbidity and mortality caused by non-communicable diseases. Social determinants, such as socioeconomic status, education, neighborhood, physical environment, employment, social support networks, and access to health care, play a crucial role in influencing health outcomes and health inequities within populations. Social determinants and stress in women are interconnected factors that can significantly impact women’s health and well-being. Pregnancy is a good time to engage young women and introduce them to beneficial behaviors, such as adopting essential life skills, especially diet, and learning stress management techniques. Stress influences diet, and women are more likely to engage in unhealthy eating behaviors such as emotional eating or coping with stress with food. Strong action is needed to improve women’s lifestyle starting at a young age considering that this lays the foundation for a lower cardiovascular risk in adults and the elderly. The objective of this review is to examine cardiovascular primary prevention in young healthy women, focusing particularly on unresolved issues and the influence of social determinants, as well as the correlation with stressors and their influence on diet.
... Pregnancy is associated with a greater risk of arrhythmias due to multiple causes, including neurohormonal and autonomic changes, expanded blood volume, a roughly 20% increase in the heart rate from prepregnancy rates, decreased parasympathetic and increased sympathetic activity, and emotional changes. 1,2 An increasing trend in maternal mortality has been reported in the United States, and as of 2019, maternal deaths are estimated to be around 20.1 per 100,000 live births. 3 The risk of arrhythmias is high in women with structural heart disease, and arrhythmias during pregnancy are significant predictors of cardiac events during pregnancy. ...
Cardiovascular disease significantly jeopardizes pregnancies in the United States, impacting 1% to 4% of pregnancies annually. Among complications, cardiac arrhythmias are prevalent, posing concerns for maternal and fetal health. The incidence of arrhythmias during pregnancy is rising, partly due to advances in congenital heart surgery and a growing population of women with structural heart disease. While most arrhythmias are benign, the increasing prevalence of more serious arrhythmias warrants a proactive approach. Guidance and reassurance suffice in many cases, but persistent symptoms require cautious use of antiarrhythmic drugs or other therapies for a safe outcome. Managing more serious arrhythmias requires a comprehensive, multidisciplinary approach involving specialists, including maternal-fetal medicine physicians, cardiologists, electrophysiologists, and anesthesiologists.
... Supraventricular tachycardias and other atrioventricular nodal dependent tachycardias during pregnancy can be acutely treated by adenosine. Ventricular arrhythmias during pregnancy can be managed by the use of implantable cardioverter-defibrillator (Adamson & Nelson-Piercy, 2008;Cox & Gardner, 1993;Enriquez et al., 2014;Ferrero et al., 2004;Fischer et al., 2021;Greyling et al., 2021;Joglar & Page, 1999;Page, 1995). ...
... The heightened susceptibility to arrhythmic events in pregnant women results from a complex interplay of autonomic, hormonal, and cardiovascular modifications ( Figure 1) [2]. Specifically, heightened levels of plasma catecholamines, amplified ventricular end-diastolic volume resulting from intravascular volume expansion, mechanical effect of atrial stretch, and the multifaceted influence of hormonal and emotional changes collectively promote a proarrhythmic environment [11,12]. ...
... The heightened susceptibility to arrhythmic events in pregnant women results from a complex interplay of autonomic, hormonal, and cardiovascular modifications ( Figure 1) [2]. Specifically, heightened levels of plasma catecholamines, amplified ventricular end-diastolic volume resulting from intravascular volume expansion, mechanical effect of atrial stretch, and the multifaceted influence of hormonal and emotional changes collectively promote a proarrhythmic environment [11,12]. Cardiac output (CO) increases throughout pregnancy. ...
... If the patient is hemodynamically unstable, immediate synchronized cardioversion of AF and atrial flutter is indicated [11,108]. Indeed, every condition characterized by hemodynamic deterioration may cause placental hypoperfusion. ...
Pregnancy is closely associated with an elevated risk of arrhythmias, constituting the predominant cardiovascular complication during this period. Pregnancy may induce the exacerbation of previously controlled arrhythmias and, in some instances, arrhythmias may present for the first time in pregnancy. The most important proarrhythmic mechanisms during pregnancy are the atrial and ventricular stretching, coupled with increased sympathetic activity. Notably, arrhythmias, particularly those originating in the ventricles, heighten the likelihood of syncope, increasing the potential for sudden cardiac death. The effective management of arrhythmias during the peripartum period requires a comprehensive, multidisciplinary approach from the prepartum to the postpartum period. The administration of antiarrhythmic drugs during pregnancy necessitates meticulous attention to potential alterations in pharmacokinetics attributable to maternal physiological changes, as well as the potential for fetal adverse effects. Electric cardioversion is a safe and effective intervention during pregnancy and should be performed immediately in patients with hemodynamic instability. This review discusses the pathophysiology of arrythmias in pregnancy and their management.
... The most common presentation is palpitations. In more than 50% of pregnant women investigated for palpitations, ectopic beats, and non-sustained arrhythmias were recorded while sustained tachycardias account to 2-3 per 1,000 cases [2]. These cases can be managed effectively with conservative management in the forms of medical cardioversion or electro-cardioversion. ...
... Amniodarone was also given to our patient and should only be used for short-term use. If used for prolonged periods, it can cause fetal hypothyroidism or fetal hyperthyroidism, goiter, IUGR, and prematurity [2]. It provided a gradual decrease in the maternal heart rate of our patient to 180's beats per minute. ...
... the heart [8,9]. The decision to treat a woman depends upon the frequency, duration, and tolerability of the arrhythmia [2]. ...
... This results in early after depolarisation, a shortened refractory period along with slower conduction through activation of ion channels. 5 Oestrogens and progestogen are proarrhythmic and enhance cardiac automaticity and adrenergic responsiveness during pregnancy. 6 Oestrogens cause increased expression of L-type calcium channels in the sinoatrial node and sustain a faster HR through accelerated calcium entry and subsequent intracellular calcium release. ...
... When investigating a pregnant patient with an arrhythmia, the emphasis should be on obtaining a thorough history of symptoms, the time of the day of their occurrence, their severity, length of episodes, and the precipitating and relieving factors. 5 Sinus tachycardia may be asymptomatic whereas some arrhythmias may be detected incidentally on a wearable device. 25 An exhaustive list of the investigations that may have to be tailored as per the history and possible aetiology are described in Fig 1. Whilst investigating an arrhythmia, other causes such as pulmonary embolism, IHD and aortic dissection may need to be ruled out especially in the presence of chest pain and syncope. ...
... In pregnant patients with a previous arrhythmia, recurrence and exacerbation during pregnancy are common and often exert an unfavorable effect on fetal and neonatal outcomes [40]. The maternal arrhythmias are a more frequent recurrence of a previously diagnosed arrhythmia in patients with structural heart disease [41]. This study revealed an exacerbation of a previous arrhythmia in 29.2%, very close to what the above-cited Tawam et al. [39] reported, whereas the new onset incidence was 57.1%. ...
Introduction:
Refractory arrhythmias during pregnancy pose challenges to physicians.
Aim:
To give an overview of catheter ablation for tachyarrhythmias during pregnancy, and to discuss the indications of the procedure and the outcomes of both mother and fetus.
Material and methods:
The study materials were based on comprehensive literature retrieval of the pertinent articles published since 2000.
Results:
The indications for catheter ablation were refractory arrhythmias unresponsive to drug therapy in most of the cases followed by requirement of cardioversion. Atrioventricular nodal reentrant tachycardia was the most common arrhythmia developed during pregnancy. Pregnancy complications were present in 2.4% of the cases. There was no mortality among the pregnant patients. Fetal adverse events occurred in 3.1% of the cases, more in the fluoroscopy than in the zero-fluoroscopy group. The patient cohort with a radiation dose of > 50 mGy in one-third of the cases had a 14.3% fetal adverse event rate. Fetal adverse events occurred only in the second trimester, not in the other two trimesters.
Conclusions:
Drug-refractory and poorly tolerated tachycardias in pregnant patients warrant catheter ablation. Zero-fluoroscopy technique under guidance with three-dimensional mapping systems is preferred and strict minimal fluoroscopy is only used in extreme necessity. As ablation in the second trimester was associated with a probable higher fetal adverse event rate, it is suggested that ablation is preferably performed in the third trimester.
... Increase in arrhythmogenesis during pregnancy also affects women with no previous positive cardiological history. For every third pregnant woman with an arrhythmia detected during pregnancy, it is her first attack of arrhythmia [2]. The occurrence of dangerous ventricular arrhythmias and polymorphic ventricular tachycardia, which may lead to syncope or sudden cardiac death, is mostly caused by prolongation of the QTc interval [3]. ...
Background:
Pregnancy is a condition in which new cardiac arrhythmias can occur or prior undiagnosed arrhythmias may provide symptoms. The occurrence of severe ventricular arrhythmias and polymorphic ventricular tachycardia that may lead to fainting or sudden cardiac death is promoted by the prolongation of the QTc interval. The post-partum adaptation period is the most arrhythmogenic. TpTe (Tpeak-Tend interval) is a novel marker of arrhythmogenesis by many considered a more sensitive marker than QTc.
Objective:
The aim of our work was to determine the TpTe interval (Tpeak-Tend) in women in the first, second and third trimester of pregnancy and the post-partum period.
Materials and methods:
The study group consisted of 128 women in pregnancy or postpartum and a control group of 32 non-pregnant women. A standard 12-lead ECG (electrocardiograph) recording with evaluation of the duration of TpTe and QTc was performed in all patients.
Results:
In comparison to the non-pregnant women, higher values of QTc and TpTe were observed starting in the first trimester with highest values observed in the postpartum period. Mean duration of TpTe interval during pregnancy (81.59 ± 5.92 ms) and in the whole study group (pregnancy + postpartum) (85.46 ± 6.45 ms) was significantly longer (p < 0.001) compared to the TpTe interval in the control group (74.06 ± 6.14 ms). During pregnancy and postpartum, the increase in the TpTe interval in comparison to the increase in the QTc parameter (31.10% vs. 4.18%) was significantly higher (p < 0.001).
Conclusions:
The study showed an increase in the duration of the TpTe interval and QTc parameter during pregnancy and postpartum with the highest values in the postpartum period. TpTe interval increase was significantly higher compared to QTc increase during pregnancy and postpartum. Changes of TpTe interval were not associated with any clinical outcome or measure of arrythmia burden. Further studies are needed in order to see the clinical significance of these ECG findings, in particular for larger groups of patients with automatic measurement in correlation with echocardiography.
... In relative terms, the management of non-gestational SVT is straightforward with vagal manoeuvres preceding a handful of common drugs and the underlying option for direct current cardioversion in refractory or unstable cases [4]. However, in the obstetric context an additional element of complexity is introduced for each area level of the standard SVT treatment algorithm. ...
A 36 year old woman with chest pain and palpitations at 34 weeks gestation (gravidity 2, parity 1) presented to the emergency department where she was found to be in supraventricular tachycardia (SVT). This patient had an earlier episode of SVT during the same pregnancy that was managed with intravenous adenosine. During both presentations a REVERT trial style ‘modified’ Valsalva manoeuvre (including supine positioning with passive leg raise) was attempted without success. Acknowledging the potential for vena caval compression in pregnant patients while in the Trendelenburg position, the same manoeuvre was attempted with the novel additional of 45 degree left pelvic tilt. This ‘modified’ modified Valsalva was successful in restoring sinus rhythm, suggesting this technique may warrant further investigation as a viable treatment for pregnant patients with hemodynamically stable SVT.
... Further, studies that reported sensitivity and specificity (or equivalent raw data), and those published in English were included. Studies on pregnant or paediatric populations were excluded due to associated increased sinus arrhythmias (26). Animal studies, commentaries, and reviews were also excluded. ...
Background:
Atrial fibrillation (AF) is a prevalent and preventable cause of stroke and mortality.
Aim:
This systematic review and meta-analysis aimed to investigate the sensitivity and specificity of office and out-of-office automated blood pressure (BP) devices to detect AF.
Methods:
Diagnostic studies, extracted from databases such as Ovid Medline and Embase, on AF detection by BP device(s), electrocardiography, and reported sensitivity and specificity, were included. Screening of abstracts and full texts, data extraction, and quality assessment were conducted independently by two investigators using Covidence software. The sensitivity and specificity of the BP devices were pooled using a random-effects model.
Results:
Sixteen studies including 10,158 participants were included. Only a few studies were conducted in primary care (n = 3) or with a low risk of bias (n = 5). Office BP devices, which utilised different algorithms to detect AF, had a sensitivity and specificity of 96.2 and 94%, respectively. Specificity was reduced when only one positive result was considered among consecutive BP measurements. Only a few studies (n = 3) investigated out-of-office BP. Only one study (n = 100) suggested the use of ≥79 and ≥26% of positive readings on 24-h ambulatory BP measurements to detect AF and paroxysmal AF, respectively.
Conclusions:
Office BP devices can be used clinically to screen for AF in high-risk populations. Clinical trials are needed to determine the effect of AF screening using office BP devices in reducing stroke risk and mortality. Further studies are also required to guide out-of-office use of BP devices for detecting paroxysmal AF or AF.
Systematic review registration:
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022319541, PROSPERO CRD42022319541.
