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Frequency and outcome of arrhythmias complicating admission during pregnancy: experience from a high-volume and ethnically-diverse obstetric service
Open accessAbstract
BACKGROUND: Arrhythmias are reported during pregnancy, although hospitalization for these infrequent events is not fully characterized. The frequency and outcome of arrhythmias during pregnancy are unknown. METHODS: Between 1992 and 2000, there were 136,422 pregnancy-related admissions to Parkland Memorial Hospital (Dallas, TX, USA). Using the discharge diagnosis data bank and the International Classification of Disease, 9th revision, Clinical Modification (ICD-9-CM) coding system, we identified 226 admissions (218 patients) where cardiac arrhythmias and intrauterine pregnancy were both reported. RESULTS: The most common rhythm disturbances during pregnancy were sinus tachycardia (ST), sinus bradycardia (SB), or sinus arrhythmia (SA) (104 episodes/100,000 pregnancies). This was followed by paroxysmal supraventricular tachycardia (PSVT) and premature beats, with a frequency of 24/100,000 and 33/100,000, respectively. Paroxysmal supraventricular tachycardia occurred most frequently in the third trimester or peripartum. All episodes terminated spontaneously or were safely terminated with medical therapy. Advanced heart block or lethal arrhythmias were exceedingly rare during pregnancy. CONCLUSION: Most frequently reported cardiac arrhythmias in pregnancy are benign and do not require intervention. Supraventricular tachycardia (SVT), being one of the most common complicated cardiac arrhythmias during pregnancy, can be treated effectively and safely with standard medical therapy. Ventricular arrhythmias or high-degree atrioventricular block (AVB) during pregnancy are extremely rare. Cardiac arrest is also rare, and is often caused by a different etiology from the conventional ones for sudden cardiac death.
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“The exact incidence of PSVT during pregnancy is not well established, but seems to be relatively low.395”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [395]
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“In women with CHD, supraventricular tachycardias are also associated with increased maternal morbidity and mortality.(16)”
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“The prevalence of premature atrial contractions and premature ventricular contractions is high during pregnancy and supraventricular tachycardia is the most common sustained arrhythmia encountered during pregnancy, with a prevalence of 24 per 100,000 pregnancies [76].”
BackgroundCumyn, A., Sauvé, N., & Rey, É. (2017) · Obstetric Medicine · doi:10.1177/1753495x16685684 · Cited by 8
“A review of hospital admissions for cardiac arrhythmia in pregnancy showed sinus arrhythmia/tachycardia/bradycardia in 60%, premature atrial/ventricular contractions in 19% and supraventricular tachycardia in 14%.(5) Atrial fibrillation (AF) in the absence of congenital or acquired heart disease is therefore rare and…”
BackgroundEvaluation of Syncope and Palpitations in Women
Misiri, J., Candler, S. A., & Kusumoto, F. M. (2011) · Journal of Women s Health · doi:10.1089/jwh.2010.2636 · Cited by 8
“15–19 Several case reports have described pregnant patients with syncope in the sitting or supine position from obstruction of venous return from the gravid uterus associated with a direct decrease in stroke volume and hypotension or as a trigger for neurocardiogenic syncope and reflex bradycardia…”
Lactation safety of cardiovascular medications
Nunez-Pellot, C., Akers, A., Običan, S. G., Cain, M. A., & Crousillat, D. R. (2025) · American Heart Journal Plus Cardiology Research and Practice · doi:10.1016/j.ahjo.2025.100552 · Cited by 7
“In a study performed from 1992 to 2000, the prevalence of admissions secondary to cardiac arrhythmias in all pregnant patients admitted to a Dallas, Texas hospital was 166/100,000 [52].”
Varrias, D., Sharma, N., Hentz, R. C., Ma, R., Gurciullo, D., Kleiman, J., Kossack, A., Wolf, E., Lam, B., Bimal, T., et al. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-05012-3 · Cited by 7
“Physiologic changes during pregnancy predispose women to arrhythmias, notably supraventricular tachycardia, atrial fibrillation, and ventricular arrhythmias and women with arrhythmias during pregnancy have greater incidence of in-hospital death as well as maternal or fetal complications [6] especially for those women…”
BackgroundThakkar, A., Kwapong, Y. A., Patel, H., Minhas, A., Vaught, A. “. J., Gavin, N. R., Zakaria, S., Blumenthal, R. S., Wu, K. C., Chrispin, J., et al. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.1000298 · Cited by 7
Approach to Ventricular Arrhythmias in the Intensive Care Unit
Senaratne, J. M., Sandhu, R. K., Barnett, C. F., Grunau, B. E., Wong, G. C., & van Diepen, S. (2020) · Journal of Intensive Care Medicine · doi:10.1177/0885066620912701 · Cited by 7
“There is a high frequency of supraventricular tachycardias with pregnancy (24/100 000 pregnancies), while the relative frequency of ventricular tachycardia and ventricular fibrillation is low (2/100 000) as in cardiac arrest (6/100 000).(76) Amniotic fluid embolus, peripartum cardiomyopathy, obstetrical hemorrhage, an…”
BackgroundSaha, T., Norris, R., & Luebbert, J. J. (2017) · HeartRhythm Case Reports · doi:10.1016/j.hrcr.2017.11.002 · Cited by 7
“Discussion While palpitations and single PVCs are common in pregnancy,(7) cardiac arrest due to primary arrhythmia is distinctly uncommon.(8) It was fortuitous that our patient was around trained professionals and an accessible AED.”
Coulter, S., Lew, J., & Jenny, B. E. (2019) · Cardiovascular medicine · doi:10.1007/978-1-4471-2840-3_12 · Cited by 5
Paroxysmal Supraventricular Tachycardia
Mankowitz, S. L. (2018) · Springer eBooks · doi:10.1007/978-3-319-59680-8_119 · Cited by 7
The Challenge of Pregnancy in Women With Hypertrophic Cardiomyopathy
Lloji, A., & Panza, J. A. (2021) · Cardiology in Review · doi:10.1097/crd.0000000000000394 · Cited by 6
Rajendran, A., Vakil, R. M., Yang, E., & Chrispin, J. (2023) · Contemporary cardiology · doi:10.1007/978-3-031-34103-8_25 · Cited by 6
Case 2-2021: A 26-Year-Old Pregnant Woman with Ventricular Tachycardia and Shock
Scott, N. S., Thomas, S. S., Yeh, D. D., Fox, A. S., & Smith, R. N. (2021) · New England Journal of Medicine · doi:10.1056/nejmcpc2027086 · Cited by 6
Electrocardiographic indices and pregnancy: A focus on changes between first and third trimesters
Omidi, N., Khorgami, M., Khatami, F., & Mahalleh, M. (2021) · Revista Portuguesa de Cardiologia · doi:10.1016/j.repc.2021.02.018 · Cited by 6
Apple Watch-guided diagnosis of AVNRT in a pregnant woman—A case report and literature review
Hawryszko, M., Sławiński, G., Kozłowski, D., & Lewicka, E. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.985421 · Cited by 6
Cardiac Arrhythmias and Pregnancy
SPEARS, D. A., & Elkayam, U. (2019) · Wiley eBooks · doi:10.1002/9781119409861.ch15 · Cited by 6
Interventional Cardiology Journal
(2019) · Interventional Cardiology Journal · doi:10.21767/2471-8157 · Cited by 6
Wang, H., Wang, J., Jing, W., Dai, S., Zhang, D., Geng, S., Wang, H., & Hong, S. (2025) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-025-02952-6 · Cited by 5
Management of the Fontan patient during pregnancy
Gupta, T., Thompson, J. L., & Lindley, K. J. (2023) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000001046 · Cited by 5
“For example, 20% of patients with preexisting supraventricular tachycardia will experience symptomatic exacerbations during pregnancy and should consider undergoing ablation prior to conception if able [25,31].”
BackgroundCardiac Arrhythmias During Pregnancy.
Safavi‐Naeini, P., Sorurbakhsh, N. Z., & Razavi, M. (2021) · PubMed Central · doi:10.14503/thij-21-7548 · Cited by 2
Alexis, A., Origer, P., Hacquebard, J.-P., de Cannière, D., Germay, O., Vandenbossche, J.-L., & Kapessidou, Y. (2019) · Case Reports in Anesthesiology · doi:10.1155/2019/4181502 · Cited by 5
“A review of hospital admissions for cardiac arrhythmia in pregnancy showed sinus arrhythmia (tachycardia/bradycardia) in 60%, premature (atrial/ventricular) contractions in 19%, supraventricular tachycardia in 14% and rare cases of atrial fibrillation (AF) in the absence of underlying heart disease (1%) [7, 8].”
BackgroundManagement of palpitations and cardiac arrhythmias in pregnancy
Roberts, A., Mechery, J., Mechery, A., Clarke, B., & Vause, S. (2019) · The Obstetrician & Gynaecologist · doi:10.1111/tog.12599 · Cited by 4
Cardiovascular Health in Women—Across the Lifespan
Chandrasekhar, J., Yao, J. V., Gong, S., Wijayarathne, P. M., Watts, M., & Mukherjee, S. (2025) · Clinical Endocrinology · doi:10.1111/cen.70027 · Cited by 5
Management of Cardiovascular Disease in Women
Mieszczanska, H. Z., & Velarde, G. P. (2014) · Springer eBooks · doi:10.1007/978-1-4471-5517-1 · Cited by 3
Management of recurrent and refractory ventricular tachycardia in pregnancy
Lin, L., Tsui, K., Chang, R., Cheng, J., Huang, B., & Wang, P. (2015) · Taiwanese Journal of Obstetrics and Gynecology · doi:10.1016/j.tjog.2015.04.002 · Cited by 3
Sharma, N., Coleman, K. M., Ma, R., Gurciullo, D., Bimal, T., Ansari, U., Wolf, E., Liu, Y., Hentz, R. C., & Mountantonakis, S. (2022) · Open Heart · doi:10.1136/openhrt-2022-002117 · Cited by 3
Elektrische Kardioversion von Vorhofflimmern – DGK‑Positionspapier
Lüker, J., Vollmann, D., Iden, L., Jansen, H., Rottner, L., Bogossian, H., Perings, C. A., Birkemeyer, R., & Eckardt, L. (2025) · Die Kardiologie · doi:10.1007/s12181-025-00769-1 · Cited by 3
La prise en charge thérapeutique des troubles du rythme cardiaque au cours de la grossesse
Fennira, S., Khaldi, M. H., Rejeb, M. A., Ellouze, Y., Kraiem, S., & Slimane, M. L. (2011) · Annales de Cardiologie et d Angéiologie · doi:10.1016/j.ancard.2010.12.003 · Cited by 3
Sengupta, A., Slater, T. A., & Sainsbury, P. A. (2014) · Obstetric Medicine · doi:10.1177/1753495x14539679 · Cited by 3
“A retrospective analysis in a US centre showed only two cases of atrioventricular block in 135,000 pregnancy-related admissions over nine years.(2) Complete heart block has been reported in an Indian case series,(3) in which roughly half of the mothers underwent peripartum temporary pacing and some had permanent pacem…”
BackgroundThe Growing Culture Of A Minimally Fluoroscopic Approach In Electrophysiology Lab.
Casella, M., Russo, E., Pizzamiglio, F., Conti, S., Al-Mohani, G., Colombo, D., Casula, V., D’Alessandra, Y., Biagioli, V., Carbucicchio, C., et al. (2014) · PubMed Central · doi:10.4022/jafib.1104 · Cited by 3
Arrhythmia in pregnancy: Approaches to diagnosis and management
Roelas, M., Whitaker, J., Teelucksingh, S., & de Marvao, A. (2025) · JRSM Cardiovascular Disease · doi:10.1177/20480040251391929 · Cited by 2
“13,19 In patients with a structurally normal heart, atrioventricular node re-entrant tachycardia (AVNRT) is the most common mechanism.”
Metadata
- Authors
- Li, J., Nguyen, C., Joglar, J. A., Hamdan, M. H., & Page, R. L.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- University of Utah (US)
- University of Washington (US)
- Venue
- Clinical Cardiology
- Publisher
- Wiley
- Published
- 2008-11
- Volume
- 31
- Issue
- 11
- Pages
- 538-541
- ISSN
- 0160-9289 (ISSN-L)
- 1932-8737
- PMC
- PMC6653406
- OpenAlex
- W2125081604
- Cited by
- 165
- References
- 7
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 5 · 2023: 9 · 2022: 17 · 2021: 21 · 2020: 19 · 2019: 12 · 2018: 14 · 2017: 6 · 2016: 8 · 2015: 6 · 2014: 7 · 2013: 3 · 2012: 7
- FWCI
- 3.88
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Cardiology (publishedVersion, public-domain)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Issues in Pregnancy
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- cardiac arrhythmias in pregnancy, sinus tachycardia, sinus bradycardia, sinus arrhythmia, paroxysmal supraventricular tachycardia, extrasystoles, atrioventricular block, ventricular arrhythmias, cardiac arrest, peripartum, medical therapy
- MeSH terms
- Adolescent, Arrhythmias, Cardiac, Female, Heart Arrest, Hospitalization, Humans, Length of Stay, Pregnancy, Pregnancy Complications, Cardiovascular, Retrospective Studies, Risk Factors, United States, Incidence, Death, Sudden, Cardiac, Treatment Outcome, Young Adult
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