Managing palpitations and arrhythmias during pregnancy

Arrhythmias in pregnancy are common and may cause concern for the wellbeing of both the mother and the fetus. For some mothers the arrhythmias may be a recurrence of a previously diagnosed arrhythmia or the first presentation in a woman with known structural heart disease. In most cases, however, there is no previous history of heart disease, and the new occurrence of a cardiac problem can generate considerable anxiety. The majority of arrhythmias that occur during pregnancy are benign, and simply troublesome; hence, advice about appropriate actions during symptomatic episodes, together with reassurance, is usually all that is required. In the remaining minority of cases, judicious use of antiarrhythmic drugs will lead to a safe and successful outcome for both mother and baby. While there were no documented maternal deaths from primary arrhythmias in the last UK confidential enquiry into maternal mortality,1 9% of cardiac deaths were defined as sudden adult death syndrome, which raises the possibility of death from a primary arrhythmia. In women with known structural heart disease, however, arrhythmia is one of the five independent predictors of having a cardiac event during the pregnancy and should therefore be treated seriously.2