How to Manage Arrhythmias During Pregnancy?

Arrhythmia is experiencing irregular heartbeats and it is quite common during pregnancy. However, it can affect the wellbeing of the mother and the foetus inside and thus needs proper diagnosis and treatment. There may or may not be a history of heart disease in mothers suffering from arrhythmias and most of the attacks due to arrhythmias are benign.  Appropriate actions during an attack is all that is required to ensure that the mother and foetus are safe. In other cases, anti-arrhythmic drugs are administered.


The treatment or management of arrhythmias during pregnancy depends on the type of the same. The types include:

  • Supraventricular arrhythmias: Several types come under this like atrial premature beats, paroxysmal supraventricular tachycardia, focal atrial tachycardias, atrial fibrillation, and the treatment depends on the symptoms to a great extent. Cardioselective beta blockers are prescribed if the symptoms become intolerable. Electrical cardioversion is recommended to hemodynamic unstable patients. If the patient is stable, adenosine and manoeuvres are prescribed. Other lines of treatment can be followed depending upon the symptoms.
  • Ventricular arrhythmias: The types under this are ventricular premature beats, idiopathic ventricular tachycardia, hypertrophic cardiomyopathy, peripartum cardiomyopathy and others. For the first type beta blockers are recommended and also metoprolol is another preferred choice of the doctors as it has no side effects on the foetus. Cardioversion is needed in case of peripartum cardiomyopathy. Some of drugs used in these cases include sotalol, metoprolol, lidocaine, and amiodarone.

The treatment process depends on several factors like duration, frequency, and tolerability of the ailment. A balance between reducing or termination of arrhythmias attack and the side effects to the mother and foetus is what is taken into account while deciding the drug.

Also, there is still no strong evidence to prove the safety of medications against arrhythmic attacks on pregnant women and the use of antiarrhythmic drug is restricted to severe cases—in case of extreme hemodynamic instability symptoms. Also, it is best to use the fewest number of medicines with the lowest doses.

It’s really important to understand arrhythmic symptoms can be treated if you get the help in time. If you are pregnant and you experience dizziness and/or palpitations, a thorough clinical assessment is what you need. Make sure that you talk to your doctor about the same. A detailed clinical checkup will help the diagnosis of the type of arrhythmias, you have, and the line of action and treatment will depend on that. Tests will include full blood count, ECG, renal function, echocardiography, thyroid function, and electrolyte test.

Electrical cardioversion is mandatory in all sustained cases of arrhythmias with hemodynamic instability symptoms. In case of structurally normal heart beats, Paroxysmal supraventricular tachycardia is the most common type of arrhythmias and it can be treated easily with the use of AV node blocking agents and vagal manoeuvres. Rhythmic strategic control is recommended in case of atrial fibrillation. Ventricular arrhythmia is not very common and the management is same as in case of non pregnant women.