Arrhythmias and conduction disorders are the most common cardiac complications encountered during pregnancy in women with and without structural heart disease [1-3]. They may manifest for the first time during pregnancy, and in other cases, pregnancy can trigger exacerbations in women with pre-existing arrhythmias [1,4-6]. Women with established arrhythmias or structural heart disease are at highest risk of developing arrhythmias during pregnancy. Due to surgical advances, there has been an increase in the number of women of childbearing age with congenital heart disease and this group of women is at particularly high risk for arrhythmias (figure 1) [1,2,7-11]. Because of these associations, any woman who presents with an arrhythmia should have a clinical work up (including an electrocardiogram and a transthoracic echocardiogram) for evidence of structural heart disease.
In general, the approach to the treatment of conduction disturbances and bradycardia in pregnant women is similar to that in the nonpregnant patient. Treatment strategies during pregnancy are hampered by the lack of randomized trials in this cohort of women. Choice of therapy, for the most part, is based on limited data from case reports, observational studies, and clinical experience.
The prevalence, clinical presentation, and management of conduction disorders and bradycardia during pregnancy will be reviewed here. Electrocardiographic characteristics of sinus bradycardia and conduction disorders are discussed in detail elsewhere. (See "ECG tutorial: Rhythms and arrhythmias of the sinus node" and "ECG tutorial: Atrioventricular block".)
Issues relating to supraventricular and ventricular arrhythmias, as well as cardiac arrest during pregnancy, are discussed separately. (See "Management of cardiopulmonary arrest in pregnancy" and "Supraventricular arrhythmias during pregnancy" and "Ventricular arrhythmias during pregnancy".)
Palpitations occur frequently during pregnancy and are a common indication for cardiac evaluation during pregnancy. The differential diagnosis of palpitations is extensive and the diagnostic evaluation of pregnant women with palpitations does not differ from nonpregnant women. (See "Overview of palpitations in adults".)