Atrial fibrillation pregnancy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.
Overview
Atrial Fibrillation and Pregnancy
- The presence of atrial fibrillation is rare in pregnancy and has an identifiable underlying etiology such as mitral stenosis, congenital heart disease, or hyperthyroidism. Therefore in a pregnant patient with atrial fibrillation, underlying heart diseases should be evaluated first. [1][2][3][4]
- Fetal growth surveillance is critical in pregnant patients with atrial fibrillation.[4]
- Digoxin, beta blocker or non-dihydropyridine CCB may be used to control the ventricular rate.[5][6][7]
- Quinidine has been shown to be safe in pregnancy and remains the drug of choice for pharmacological cardioversion of atrial fbrillation in pregnancy.[8]
- Cardioversion is the treatment of choice in pregnanct patients with persistent atrial fibrillation.[4]
- In cases of hemodynamic instability, direct-current cardioversion may be performed without fetal damage.[9]
2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[10]
Pregnancy (DO NOT EDIT) [10]
| Class I |
| "1. Digoxin, beta blockers, or non dihydropyridine calcium channel antagonists are recommended to control the rate of ventricular response in pregnant patients with atrial fibrillation. (Level of Evidence: C)" |
| "2. Direct-current cardioversion is recommended in pregnant patients who become hemodynamically unstable due to atrial fibrillation. (Level of Evidence: C)" |
| "3. Protection against thromboembolism is recommended throughout pregnancy for all patients with atrial fibrillation (except those with lone atrial fibrillation 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 atrial fibrillation 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 atrial fibrillation (AF) and risk factors for thromboembolism. (Level of Evidence: B)" |
| "3. Administration of an oral anticoagulant may be considered during the second trimester for pregnant patients with atrial fibrillation (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 atrial fibrillation (AF) during pregnancy. (Level of Evidence: C)" |
Sources
- 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation [11]
- ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter [12]
References
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 4.0 4.1 4.2 DiCarlo-Meacham LA, Dahlke LJ (2011). "Atrial fibrillation in pregnancy". Obstet Gynecol. 117 (2 Pt 2): 489–492. doi:10.1097/AOG.0b013e31820561ef. PMID 21252800.
- ↑ Page RL (1995) Treatment of arrhythmias during pregnancy. Am Heart J 130 (4):871-6. PMID: 7572599
- ↑ Chow T, Galvin J, McGovern B (1998) Antiarrhythmic drug therapy in pregnancy and lactation. Am J Cardiol 82 (4A):58I-62I. PMID: 9737655
- ↑ 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
- ↑ Vaughan Williams EM (1984) A classification of antiarrhythmic actions reassessed after a decade of new drugs. J Clin Pharmacol 24 (4):129-47. PMID: 6144698
- ↑ 9.0 9.1 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
- ↑ 10.0 10.1 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 developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". J Am Coll Cardiol. 57 (11): e101–98. doi:10.1016/j.jacc.2010.09.013. PMID 21392637.
- ↑ 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
- ↑ 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