Arrhythmias During Pregnancy and Postpartum

The incidence of cardiac arrhythmias during pregnancy is increasing, and the distribution of presenting arrhythmias is changing with an evolving maternal population. Atrial fibrillation is now the most common arrhythmia in pregnancy, but all types of arrhythmia and structural heart disease may be encountered. These arrhythmias may be associated with worse maternal and fetal outcomes. There are minimal data to guide management and decision-making in this patient population, and therapy should be reserved for those with severe symptoms. Diagnostic and therapeutic interventions should be avoided, if possible, during the first trimester. Antiarrhythmic drugs with the longest safety record should be used first. In the case of refractory arrhythmias, catheter ablation and device therapy can be performed utilizing techniques to minimize ionizing radiation.