Atrial fibrillation pregnancy: Difference between revisions

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| colspan="3" align="center" bgcolor="#ABCDEF" | Conduction
| colspan="3" align="center" bgcolor="#ABCDEF" | Conduction
|-
|-
| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|230px]]
| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|75px]]
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|230px]]  
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|100px]]  
|}
|}
{{Infobox_Disease |
{{Infobox_Disease |
   Name          = Atrihttp://miles.wikidoc.org/skins/common/images/button_bold.pngal fibrillation |
   Name          = |
   Image          = SinusRhythmLabels.png |
   Image          =  |
   Caption        = The P waves, which represent depolarization of the atria, are irregular or absent during atrial fibrillation. |
   Caption        = |
   DiseasesDB    = 1065 |
   DiseasesDB    = 1065 |
   ICD10          = {{ICD10|I|48||i|30}} |
   ICD10          = {{ICD10|I|48||i|30}} |
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   OMIM          = |
   OMIM          = |
   MedlinePlus    = 000184 |
   MedlinePlus    = 000184 |
   eMedicineSubj  = med |
   eMedicineSubj  = |
   eMedicineTopic = 184 |
   eMedicineTopic = |
   eMedicine_mult = {{eMedicine2|emerg|46}} |  
   eMedicine_mult = |  
}}
}}
{{SI}}
{{Atrial fibrillation}}
{{WikiDoc Cardiology Network Infobox}}
{{CMG}}


'''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[Varun Kumar, M.B.B.S.]]


{{Editor Join}}
'''''Synonyms and related keywords:''''' AF, Afib, fib
 
'''Synonyms and related keywords''': AF, Afib, fib


==Overview==
==Overview==
The presence of [[atrial fibrillation]] is rare in pregnancy and has an identifiable underlying etiology such as [[mitral stenosis]],<ref name="pmid2913749">Bryg RJ, Gordon PR, Kudesia VS, Bhatia RK (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2913749 Effect of pregnancy on pressure gradient in mitral stenosis.] ''Am J Cardiol'' 63 (5):384-6. PMID: [http://pubmed.gov/2913749 2913749]</ref> [[congenital heart disease]],<ref name="pmid7113941">Whittemore R, Hobbins JC, Engle MA (1982) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7113941 Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease.] ''Am J Cardiol'' 50 (3):641-51. PMID: [http://pubmed.gov/7113941 7113941]</ref> or [[hyperthyroidism]].<ref name="pmid110126">Forfar JC, Miller HC, Toft AD (1979) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=110126 Occult thyrotoxicosis: a correctable cause of "idiopathic" atrial fibrillation.] ''Am J Cardiol'' 44 (1):9-12. PMID: [http://pubmed.gov/110126 110126]</ref> [[Digoxin]], [[beta blocker]] or [[CCB|non-dihydropyridine CCB]] may be used to control the ventricular rate.<ref name="pmid7572599">Page RL (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7572599 Treatment of arrhythmias during pregnancy.] ''Am Heart J'' 130 (4):871-6. PMID: [http://pubmed.gov/7572599 7572599]</ref><ref name="pmid9737655">Chow T, Galvin J, McGovern B (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9737655 Antiarrhythmic drug therapy in pregnancy and lactation.] ''Am J Cardiol'' 82 (4A):58I-62I. PMID: [http://pubmed.gov/9737655 9737655]</ref><ref name="pmid1721219">O'Nunain S, Garratt CJ, Linker NJ, Gill J, Ward DE, Camm AJ (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1721219 A comparison of intravenous propafenone and flecainide in the treatment of tachycardias associated with the Wolff-Parkinson-White syndrome.] ''Pacing Clin Electrophysiol'' 14 (11 Pt 2):2028-34. PMID: [http://pubmed.gov/1721219 1721219]</ref>


==ACC / AHA Guidelines- Pregnancy (DO NOT EDIT) <ref name="Fuster"> Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation- Executive Summary: executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidlines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114: 700-752. PMID 16908781 </ref>==
==ACCF/AHA/HRS 2011 Guidelines- Pregnancy (DO NOT EDIT) <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref><ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref>==
{{cquote|
{{cquote|
===Class I===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===
1. [[Digoxin]], a [[beta blocker]], or a non [[dihydropyridine]] [[calcium channel antagonist]] is recommended to control the rate of ventricular response in [[pregnant]] patients with [[AF]]. ''(Level of Evidence: C)''
'''1.''' [[Digoxin]], a [[beta blocker]], or a non [[dihydropyridine]] [[calcium channel antagonist]] is recommended to control the rate of ventricular response in [[pregnant]] patients with [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


2. [[Direct-current cardioversion]] is recommended in pregnant patients who become hemodynamically unstable due to [[AF]]. ''(Level of Evidence: C)''
'''2.''' [[Direct-current cardioversion]] is recommended in pregnant patients who become hemodynamically unstable due to [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


3. Protection against [[thromboembolism]] is recommended throughout [[pregnancy]] for all patients with [[AF]] (except those with lone [[AF]] and/or low thromboembolic risk). Therapy ([[anticoagulant]] or [[aspirin]]) should be chosen according to the stage of [[pregnancy]]. ''(Level of Evidence: C)''
'''3.''' Protection against [[thromboembolism]] is recommended throughout [[pregnancy]] for all patients with [[AF]] (except those with lone [[AF]] and/or low thromboembolic risk). Therapy ([[anticoagulant]] or [[aspirin]]) should be chosen according to the stage of [[pregnancy]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


===Class IIb===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===
1. Administration of [[heparin]] may be considered during the first trimester and last month of [[pregnancy]] for patients with [[AF]] and risk factors for [[thromboembolism]]. [[Unfractionated heparin]] may be administered either by continuous intravenous infusion in a dose sufficient to prolong the [[activated partial thromboplastin time]] to 1.5 to 2 times the control value or by intermittent subcutaneous injection in a dose of 10 000 to 20 000 units every 12 h, adjusted to prolong the mid-interval (6 h after injection) [[activated partial thromboplastin time]] to 1.5 times control. ''(Level of Evidence: B)''
'''1.''' Administration of [[heparin]] may be considered during the first trimester and last month of [[pregnancy]] for patients with [[AF]] and risk factors for [[thromboembolism]]. [[Unfractionated heparin]] may be administered either by continuous intravenous infusion in a dose sufficient to prolong the [[activated partial thromboplastin time]] to 1.5 to 2 times the control value or by intermittent subcutaneous injection in a dose of 10 000 to 20 000 units every 12 h, adjusted to prolong the mid-interval (6 h after injection) [[activated partial thromboplastin time]] to 1.5 times control. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''


2. Despite the limited data available, subcutaneous administration of [[low molecular weight heparin]] may be considered during the first trimester and last month of [[pregnancy]] for patients with [[AF]] and risk factors for [[thromboembolism]]. ''(Level of Evidence: C)''
'''2.''' Despite the limited data available, subcutaneous administration of [[low molecular weight heparin]] may be considered during the first trimester and last month of [[pregnancy]] for patients with [[AF]] and risk factors for [[thromboembolism]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


3. Administration of an oral [[anticoagulant]] may be considered during the second trimester for [[pregnant]] patients with [[AF]] at high thromboembolic risk. ''(Level of Evidence: C)''
'''3.''' Administration of an oral [[anticoagulant]] may be considered during the second trimester for [[pregnant]] patients with [[AF]] at high thromboembolic risk. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


4. Administration of [[quinidine]] or [[procainamide]] may be considered to achieve pharmacological [[cardioversion]] in hemodynamically stable patients who develop [[AF]] during pregnancy. ''(Level of Evidence: C)''}}
'''4.''' Administration of [[quinidine]] or [[procainamide]] may be considered to achieve pharmacological [[cardioversion]] in hemodynamically stable patients who develop [[AF]] during pregnancy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}


==See Also==
==Vote on and Suggest Revisions to the Current Guidelines==
* [[The Living Guidelines: Diagnosis and Management of Atrial Fibrillation | The AF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
* [[The Living Guidelines: Diagnosis and Management of Atrial Fibrillation | The AF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]


==Sources==
==Guideline Resources==
* The ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation <ref name="Fuster"> Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation- Executive Summary: executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidlines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114: 700-752. PMID 16908781 </ref>
*[http://content.onlinejacc.org/cgi/reprint/48/4/e149.pdf ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation] <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref>
 
*[http://circ.ahajournals.org/content/123/10/e269.full.pdf 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation] <ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref>
 
*[http://circ.ahajournals.org/content/117/8/1101.full.pdf ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter] <ref name="pmid18283199">Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18283199 ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society.] ''Circulation'' 117 (8):1101-20. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.187192 DOI:10.1161/CIRCULATIONAHA.107.187192] PMID: [http://pubmed.gov/18283199 18283199]</ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
==Further Readings==
{{refbegin|2}}
* Fuster V, Rydén LE, Cannom DS, et al (2006). "ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation 114 (7): e257-354. doi:10.1161/CIRCULATIONAHA.106.177292. PMID 16908781.
* Estes NAM 3rd, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS, McNamara RL, Messer JV, Ritchie JL, Romeo SJW, Waldo AL, Wyse DG. ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with non valvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Performance Measures for Atrial Fibrillation). Circulation 2008; 117:1101–1120
{{refend}}
{{Electrocardiography}}
{{Circulatory system pathology}}
{{SIB}}


[[Category:Electrophysiology]]
[[Category:Electrophysiology]]

Revision as of 17:31, 30 October 2011

Conduction
Sinus rhythm
Atrial fibrillation
'
ICD-10 I48
ICD-9 427.31
DiseasesDB 1065
MedlinePlus 000184

Atrial Fibrillation Microchapters

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Atrial fibrillation pregnancy On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.

Synonyms and related keywords: AF, Afib, fib

Overview

The presence of atrial fibrillation is rare in pregnancy and has an identifiable underlying etiology such as mitral stenosis,[1] congenital heart disease,[2] or hyperthyroidism.[3] Digoxin, beta blocker or non-dihydropyridine CCB may be used to control the ventricular rate.[4][5][6]

ACCF/AHA/HRS 2011 Guidelines- Pregnancy (DO NOT EDIT) [7][8]

“

Class I

1. Digoxin, a beta blocker, or a non dihydropyridine calcium channel antagonist is recommended to control the rate of ventricular response in pregnant patients with AF. (Level of Evidence: C)

2. Direct-current cardioversion is recommended in pregnant patients who become hemodynamically unstable due to AF. (Level of Evidence: C)

3. Protection against thromboembolism is recommended throughout pregnancy for all patients with AF (except those with lone AF and/or low thromboembolic risk). Therapy (anticoagulant or aspirin) should be chosen according to the stage of pregnancy. (Level of Evidence: C)

Class IIb

1. Administration of heparin may be considered during the first trimester and last month of pregnancy for patients with AF and risk factors for thromboembolism. Unfractionated heparin may be administered either by continuous intravenous infusion in a dose sufficient to prolong the activated partial thromboplastin time to 1.5 to 2 times the control value or by intermittent subcutaneous injection in a dose of 10 000 to 20 000 units every 12 h, adjusted to prolong the mid-interval (6 h after injection) activated partial thromboplastin time to 1.5 times control. (Level of Evidence: B)

2. Despite the limited data available, subcutaneous administration of low molecular weight heparin may be considered during the first trimester and last month of pregnancy for patients with AF and risk factors for thromboembolism. (Level of Evidence: C)

3. Administration of an oral anticoagulant may be considered during the second trimester for pregnant patients with AF at high thromboembolic risk. (Level of Evidence: C)

4. Administration of quinidine or procainamide may be considered to achieve pharmacological cardioversion in hemodynamically stable patients who develop AF during pregnancy. (Level of Evidence: C)

”

Vote on and Suggest Revisions to the Current Guidelines

Guideline Resources

References

  1. ↑ Bryg RJ, Gordon PR, Kudesia VS, Bhatia RK (1989) Effect of pregnancy on pressure gradient in mitral stenosis. Am J Cardiol 63 (5):384-6. PMID: 2913749
  2. ↑ Whittemore R, Hobbins JC, Engle MA (1982) Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. Am J Cardiol 50 (3):641-51. PMID: 7113941
  3. ↑ Forfar JC, Miller HC, Toft AD (1979) Occult thyrotoxicosis: a correctable cause of "idiopathic" atrial fibrillation. Am J Cardiol 44 (1):9-12. PMID: 110126
  4. ↑ Page RL (1995) Treatment of arrhythmias during pregnancy. Am Heart J 130 (4):871-6. PMID: 7572599
  5. ↑ Chow T, Galvin J, McGovern B (1998) Antiarrhythmic drug therapy in pregnancy and lactation. Am J Cardiol 82 (4A):58I-62I. PMID: 9737655
  6. ↑ O'Nunain S, Garratt CJ, Linker NJ, Gill J, Ward DE, Camm AJ (1991) A comparison of intravenous propafenone and flecainide in the treatment of tachycardias associated with the Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol 14 (11 Pt 2):2028-34. PMID: 1721219
  7. ↑ 7.0 7.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
  8. ↑ 8.0 8.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
  9. ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199

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