Atrial Fibrillation and Atrial Flutter in Pregnancy: Epidemiology, Pathophysiology, and Management

Importance: The prevalence of atrial fibrillation (AF) and atrial flutter (AFL) among pregnant patients has increased over time, with AF now being the most common sustained cardiac arrhythmia in pregnancy. Management of AF/AFL in pregnancy presents unique clinical challenges, with careful consideration of both maternal and fetal well-being. Objectives: To review the current evidence and expert guidance regarding the evaluation and management of AF and AFL in pregnancy, with emphasis on epidemiology, risk factors, pregnancy-specific considerations, and treatment strategies. Evidence Acquisition: Relevant literature on AF and AFL in pregnancy was reviewed, including epidemiologic data, pathophysiologic insights, pharmacologic and nonpharmacologic management approaches, and expert consensus guidelines. Key topics included maternal and fetal safety of commonly used medications, considerations for antepartum and intrapartum care, and strategies for addressing both stable and emergent arrhythmia presentations. Results: AF and AFL in pregnancy are associated with increased maternal and fetal risks. Pregnancy-specific physiological changes increase susceptibility to arrhythmia and thromboembolic complications, highlighting the importance of timely recognition and multidisciplinary management. Antepartum and intrapartum care planning is essential, including strategies for rhythm and rate control, anticoagulation, and emergency interventions. Conclusions and Relevance: As AF and AFL become more prevalent in pregnancy, clinicians must be equipped with knowledge of pregnancy-specific considerations and evidence-based management strategies to optimize maternal and fetal outcomes. Early recognition, individualized therapy, and multidisciplinary coordination are key to improving prognosis for both mother and child.