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PM.57 Refractory SVT in the Third Trimester of Pregnancy: Management Dilemmas
  1. K Merrick,
  2. S Maydanovych,
  3. U Rajesh
  1. York Teaching Hospital, York, UK

Abstract

The most frequently encountered arrhythmia, commonest in women of reproductive age, is paroxysmal supraventricular tachycardia (SVT). Atrio-ventricular nodal re-entry and Wolf-Parkinson-White syndrome account for the majority of these (1). Evidence for treatment during pregnancy is scarce due to the lack of research in this group of patients and limited information on the safety of anti-arrhythmic drugs in pregnancy. Much of the current evidence is based on case reports, animal studies, observational studies and clinical experience however, several methods appear to be reasonably safe for the patient and the fetus (2). There is limited evidence regarding the safety and use of DC cardioversion in pregnancy (3,4). Particular consideration is required to be given to the gestation and the risks of delivery when considering the various treatments including choice of routinely used first to third line antiarrhythmic agents and DC cardioversion for the more refractory situations. We describe a case of refractory SVT in a patient with a failed ablation for WPW syndrome presenting in the third trimester of pregnancy. This case highlights several management dilemmas including decisions regarding choice and dose of pharmacological agents, planning a Caesarean section for delivery of fetus prior to DC cardioversion that was required and particularly emphasises good practise with a multidisciplinary team approach at every stage of the management process.

References

  1. Lee SH, Chen SA, Wu TJ et al, Effects of pregnancy on first onset and symptoms of paroxysmal supraventricular tachycardia. Am J Cardiol 1995;76:675.

  2. Joglar J.A., Page R.L.; Treatment of cardiac arrhythmias during pregnancy: safety considerations. Drug Saf 20 1999;85–94.

  3. Klepper I. Cardioversion in late pregnancy. Anaesthesia 1981;36:611–6.

  4. Finlay AY, Edmunds V. DC cardrioversion in pregnancy. Br J Clin Pract 1979;33: 88–94.

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