Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Related articles

Ventricular arrhythmias during pregnancy

INTRODUCTION

Arrhythmias are the most common cardiac complication encountered during pregnancy in women with and without structural heart disease [1-3]. Arrhythmias may manifest for the first time during pregnancy or pregnancy can trigger exacerbations in women with known pre-existing arrhythmias [1,4-6].

The prevalence, clinical presentation and management of ventricular arrhythmias will be reviewed. Cardiac arrest during pregnancy, general management of ventricular arrhythmias and cardiac arrest, electrocardiographic characteristics of ventricular arrhythmias, and issues relating to supraventricular arrhythmias during pregnancy are discussed in detail elsewhere. (See "Cardiopulmonary arrest in pregnancy" and "Approach to the diagnosis and treatment of wide QRS complex tachycardias" and "Advanced cardiac life support (ACLS) in adults" and "ECG tutorial: Ventricular arrhythmias" and "Supraventricular arrhythmias during pregnancy".)

GENERAL APPROACH

Women with established arrhythmias or structural heart disease are at highest risk of developing arrhythmias during pregnancy. Due to surgical advances, the number of women of childbearing age with congenital heart disease has increased and this group of women is at particularly high risk for arrhythmias (figure 1) [1,2,7-11]. (See "Pregnancy in women with congenital heart disease: General principles".) Since arrhythmias are frequently associated with acquired or structural heart disease, any woman who presents with an arrhythmia during pregnancy should undergo clinical evaluation for structural heart disease (including an electrocardiogram and a transthoracic echocardiogram). (See 'VT in women with structural heart disease' below.)

In general, the approach to the treatment of arrhythmias in pregnancy is similar to that in the non-pregnant patient. However, due to the theoretical or known adverse effects of antiarrhythmic drugs on the fetus, antiarrhythmic drugs are generally reserved for the treatment of arrhythmias associated with significant symptoms or hemodynamic compromise [12-14]. 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 animal studies, case reports, observational studies, and clinical experience.

MECHANISM OF ARRHYTHMOGENESIS IN PREGNANCY

The exact mechanism of increased arrhythmia burden during pregnancy is unclear but has been attributed to hemodynamic, hormonal, and autonomic changes related to pregnancy.

                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2014. | This topic last updated: Sep 29, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Siu SC, Sermer M, Colman JM, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001; 104:515.
  2. Drenthen W, Pieper PG, Roos-Hesselink JW, et al. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol 2007; 49:2303.
  3. Drenthen W, Boersma E, Balci A, et al. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J 2010; 31:2124.
  4. Lee SH, Chen SA, Wu TJ, et al. Effects of pregnancy on first onset and symptoms of paroxysmal supraventricular tachycardia. Am J Cardiol 1995; 76:675.
  5. Doig JC, McComb JM, Reid DS. Incessant atrial tachycardia accelerated by pregnancy. Br Heart J 1992; 67:266.
  6. Silversides CK, Harris L, Haberer K, et al. Recurrence rates of arrhythmias during pregnancy in women with previous tachyarrhythmia and impact on fetal and neonatal outcomes. Am J Cardiol 2006; 97:1206.
  7. Siu SC, Sermer M, Harrison DA, et al. Risk and predictors for pregnancy-related complications in women with heart disease. Circulation 1997; 96:2789.
  8. Drenthen W, Pieper PG, Ploeg M, et al. Risk of complications during pregnancy after Senning or Mustard (atrial) repair of complete transposition of the great arteries. Eur Heart J 2005; 26:2588.
  9. Drenthen W, Pieper PG, van der Tuuk K, et al. Cardiac complications relating to pregnancy and recurrence of disease in the offspring of women with atrioventricular septal defects. Eur Heart J 2005; 26:2581.
  10. Drenthen W, Pieper PG, Roos-Hesselink JW, et al. Pregnancy and delivery in women after Fontan palliation. Heart 2006; 92:1290.
  11. Blomström-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--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 Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). Circulation 2003; 108:1871.
  12. Joglar JA, Page RL. Treatment of cardiac arrhythmias during pregnancy: safety considerations. Drug Saf 1999; 20:85.
  13. Task Force on the Management of Cardiovascular Diseases During Pregnancy of the European Society of Cardiology. Expert consensus document on management of cardiovascular diseases during pregnancy. Eur Heart J 2003; 24:761.
  14. Cox JL, Gardner MJ. Treatment of cardiac arrhythmias during pregnancy. Prog Cardiovasc Dis 1993; 36:137.
  15. Silversides CK, Colman JM. Physiological changes in pregnancy. In: Heart disease in pregnancy, 2nd ed, Oakley C, Warnes CA (Eds), Blackwell Publishing, Malden 2007. p.6.
  16. Elkayam U, Gleicher N. Hemodynamics and cardiac function during normal pregnancy and puerperium. In: Cardiac problems in pregnancy, 3rd ed, Elkayam U, Gleicher N (Eds), Wiley-Liss, New York 1998. p.3.
  17. Katz R, Karliner JS, Resnik R. Effects of a natural volume overload state (pregnancy) on left ventricular performance in normal human subjects. Circulation 1978; 58:434.
  18. Rubler S, Damani PM, Pinto ER. Cardiac size and performance during pregnancy estimated with echocardiography. Am J Cardiol 1977; 40:534.
  19. Liebson PR, Mann LI, Evans MI, et al. Cardiac performance during pregnancy: serial evaluation using external systolic time intervals. Am J Obstet Gynecol 1975; 122:1.
  20. Campos O. Doppler Echocardiography During Pregnancy: Physiological and Abnormal Findings. Echocardiography 1996; 13:135.
  21. Franz MR, Cima R, Wang D, et al. Electrophysiological effects of myocardial stretch and mechanical determinants of stretch-activated arrhythmias. Circulation 1992; 86:968.
  22. Wang Y, Joyner RW, Wagner MB, et al. Stretch-activated channel activation promotes early afterdepolarizations in rat ventricular myocytes under oxidative stress. Am J Physiol Heart Circ Physiol 2009; 296:H1227.
  23. Ninio DM, Saint DA. The role of stretch-activated channels in atrial fibrillation and the impact of intracellular acidosis. Prog Biophys Mol Biol 2008; 97:401.
  24. Kamkin A, Kiseleva I, Isenberg G. Stretch-activated currents in ventricular myocytes: amplitude and arrhythmogenic effects increase with hypertrophy. Cardiovasc Res 2000; 48:409.
  25. Soliman EZ, Elsalam MA, Li Y. The relationship between high resting heart rate and ventricular arrhythmogenesis in patients referred to ambulatory 24 h electrocardiographic recording. Europace 2010; 12:261.
  26. Zuspan FP. Catecholamines. Their role in pregnancy and the development of pregnancy-induced hypertension. J Reprod Med 1979; 23:143.
  27. Natrajan PG, McGarrigle HH, Lawrence DM, Lachelin GC. Plasma noradrenaline and adrenaline levels in normal pregnancy and in pregnancy-induced hypertension. Br J Obstet Gynaecol 1982; 89:1041.
  28. Whittaker PG, Gerrard J, Lind T. Catecholamine responses to changes in posture during human pregnancy. Br J Obstet Gynaecol 1985; 92:586.
  29. Barron WM, Mujais SK, Zinaman M, et al. Plasma catecholamine responses to physiologic stimuli in normal human pregnancy. Am J Obstet Gynecol 1986; 154:80.
  30. Ramsay MM, Broughton Pipkin F, Rubin PC. Pressor, heart rate and plasma catecholamine responses to noradrenaline in pregnant and nonpregnant women. Br J Obstet Gynaecol 1993; 100:170.
  31. Roberts JM, Insel PA, Goldfien A. Regulation of myometrial adrenoreceptors and adrenergic response by sex steroids. Mol Pharmacol 1981; 20:52.
  32. Priori SG, Mantica M, Schwartz PJ. Delayed afterdepolarizations elicited in vivo by left stellate ganglion stimulation. Circulation 1988; 78:178.
  33. Shotan A, Ostrzega E, Mehra A, et al. Incidence of arrhythmias in normal pregnancy and relation to palpitations, dizziness, and syncope. Am J Cardiol 1997; 79:1061.
  34. Newcombe PF, Renton KW, Rautaharju PM, et al. High-dose caffeine and cardiac rate and rhythm in normal subjects. Chest 1988; 94:90.
  35. Myers MG. Caffeine and cardiac arrhythmias. Ann Intern Med 1991; 114:147.
  36. Newby DE, Neilson JM, Jarvie DR, Boon NA. Caffeine restriction has no role in the management of patients with symptomatic idiopathic ventricular premature beats. Heart 1996; 76:355.
  37. Li JM, Nguyen C, Joglar JA, et al. Frequency and outcome of arrhythmias complicating admission during pregnancy: experience from a high-volume and ethnically-diverse obstetric service. Clin Cardiol 2008; 31:538.
  38. PINE HL, FOX L, SHOOK DM. PAROXYSMAL VENTRICULAR TACHYCARDIA COMPLICATING PREGNANCY. Am J Cardiol 1965; 15:732.
  39. Brodsky M, Doria R, Allen B, et al. New-onset ventricular tachycardia during pregnancy. Am Heart J 1992; 123:933.
  40. Braverman AC, Bromley BS, Rutherford JD. New onset ventricular tachycardia during pregnancy. Int J Cardiol 1991; 33:409.
  41. Shah DM, Sunderji SG. Hypertrophic cardiomyopathy and pregnancy: report of a maternal mortality and review of literature. Obstet Gynecol Surv 1985; 40:444.
  42. Autore C, Conte MR, Piccininno M, et al. Risk associated with pregnancy in hypertrophic cardiomyopathy. J Am Coll Cardiol 2002; 40:1864.
  43. Gemici G, Tezcan H, Fak AS, Oktay A. Peripartum cardiomyopathy presenting with repetitive monomorphic ventricular tachycardia. Pacing Clin Electrophysiol 2004; 27:557.
  44. Puri A, Sethi R, Singh B, et al. Peripartum cardiomyopathy presenting with ventricular tachycardia: a rare presentation. Indian Pacing Electrophysiol J 2009; 9:186.
  45. Bauce B, Daliento L, Frigo G, et al. Pregnancy in women with arrhythmogenic right ventricular cardiomyopathy/dysplasia. Eur J Obstet Gynecol Reprod Biol 2006; 127:186.
  46. Agir A, Bozyel S, Celikyurt U, et al. Arrhythmogenic right ventricular cardiomyopathy in pregnancy. Int Heart J 2014; 55:372.
  47. Iriyama T, Kamei Y, Kozuma S, Taketani Y. Management of patient with arrhythmogenic right ventricular cardiomyopathy during pregnancy. J Obstet Gynaecol Res 2013; 39:390.
  48. Doyle NM, Monga M, Montgomery B, Dougherty AH. Arrhythmogenic right ventricular cardiomyopathy with implantable cardioverter defibrillator placement in pregnancy. J Matern Fetal Neonatal Med 2005; 18:141.
  49. Lee LC, Bathgate SL, Macri CJ. Arrhythmogenic right ventricular dysplasia in pregnancy: a case report. J Reprod Med 2006; 51:725.
  50. Güdücü N, Kutay SS, Ozenç E, et al. Management of a rare case of arrhythmogenic right ventricular dysplasia in pregnancy: a case report. J Med Case Rep 2011; 5:300.
  51. Tateno S, Niwa K, Nakazawa M, et al. Arrhythmia and conduction disturbances in patients with congenital heart disease during pregnancy: multicenter study. Circ J 2003; 67:992.
  52. Whittemore R, Hobbins JC, Engle MA. Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. Am J Cardiol 1982; 50:641.
  53. Perloff JK. Pregnancy and congenital heart disease. J Am Coll Cardiol 1991; 18:340.
  54. Sasse L, Wagner R, Murray FE. Transmural myocardial infarction during pregnancy. Am J Cardiol 1975; 35:448.
  55. Sperry KL. Myocardial infarction in pregnancy. J Forensic Sci 1987; 32:1464.
  56. Hankins GD, Wendel GD Jr, Leveno KJ, Stoneham J. Myocardial infarction during pregnancy: a review. Obstet Gynecol 1985; 65:139.
  57. Curry JJ, Quintana FJ. Myocardial infarction with ventricular fibrillation during pregnancy treated by direct current defibrillation with fetal survival. Chest 1970; 58:82.
  58. O'Donnell M, Meecham J, Tosson SR, Ward S. Ventricular fibrillation and reinfarction in pregnancy. Postgrad Med J 1987; 63:1095.
  59. Sonel A, Erol C, Oral D, et al. Acute myocardial infarction and normal coronary arteries in a pregnant woman. Cardiology 1988; 75:218.
  60. Roden DM, Lazzara R, Rosen M, et al. Multiple mechanisms in the long-QT syndrome. Current knowledge, gaps, and future directions. The SADS Foundation Task Force on LQTS. Circulation 1996; 94:1996.
  61. Rashba EJ, Zareba W, Moss AJ, et al. Influence of pregnancy on the risk for cardiac events in patients with hereditary long QT syndrome. LQTS Investigators. Circulation 1998; 97:451.
  62. Sharif-Kazemi MB, Emkanjoo Z, Tavoosi A, et al. Electrical storm in Brugada syndrome during pregnancy. Pacing Clin Electrophysiol 2011; 34:e18.
  63. Onagawa T, Ohkuchi A, Ohki R, et al. Woman with postpartum ventricular tachycardia and hypomagnesemia. J Obstet Gynaecol Res 2003; 29:92.
  64. Varon ME, Sherer DM, Abramowicz JS, Akiyama T. Maternal ventricular tachycardia associated with hypomagnesemia. Am J Obstet Gynecol 1992; 167:1352.
  65. Mela T, Galvin JM, McGovern BA. Magnesium deficiency during lactation as a precipitant of ventricular tachyarrhythmias. Pacing Clin Electrophysiol 2002; 25:231.
  66. Naidoo DP, Bhorat I, Moodley J, et al. Continuous electrocardiographic monitoring in hypertensive crises in pregnancy. Am J Obstet Gynecol 1991; 164:530.
  67. Bhorat IE, Naidoo DP, Rout CC, Moodley J. Malignant ventricular arrhythmias in eclampsia: a comparison of labetalol with dihydralazine. Am J Obstet Gynecol 1993; 168:1292.
  68. Kinugawa T, Fujimoto Y, Miyakoda H, et al. A case of paroxysmal ventricular tachycardia during pregnancy. Jpn Circ J 1989; 53:807.
  69. RALLY CR, WALTERS MB. Paroxysmal ventricular tachycardia without evident heart disease. Can Med Assoc J 1962; 86:268.
  70. Lemery R, Brugada P, Bella PD, et al. Nonischemic ventricular tachycardia. Clinical course and long-term follow-up in patients without clinically overt heart disease. Circulation 1989; 79:990.
  71. Page RL, Shenasa H, Evans JJ, et al. Radiofrequency catheter ablation of idiopathic recurrent ventricular tachycardia with right bundle branch block, left axis morphology. Pacing Clin Electrophysiol 1993; 16:327.
  72. Trappe HJ, Brugada P, Talajic M, et al. Prognosis of patients with ventricular tachycardia and ventricular fibrillation: role of the underlying etiology. J Am Coll Cardiol 1988; 12:166.
  73. Sung RJ, Keung EC, Nguyen NX, Huycke EC. Effects of beta-adrenergic blockade on verapamil-responsive and verapamil-irresponsive sustained ventricular tachycardias. J Clin Invest 1988; 81:688.
  74. Chandra NC, Gates EA, Thamer M. Conservative treatment of paroxysmal ventricular tachycardia during pregnancy. Clin Cardiol 1991; 14:347.
  75. Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114:e385.
  76. Lin FC, Finley CD, Rahimtoola SH, Wu D. Idiopathic paroxysmal ventricular tachycardia with a QRS pattern of right bundle branch block and left axis deviation: a unique clinical entity with specific properties. Am J Cardiol 1983; 52:95.
  77. Cleary-Goldman J, Salva CR, Infeld JI, Robinson JN. Verapamil-sensitive idiopathic left ventricular tachycardia in pregnancy. J Matern Fetal Neonatal Med 2003; 14:132.
  78. O'Callaghan AC, Normandale JP, Morgan M. The prolonged Q-T syndrome. A review with anaesthetic implications and a report of two cases. Anaesth Intensive Care 1982; 10:50.
  79. Khositseth A, Tester DJ, Will ML, et al. Identification of a common genetic substrate underlying postpartum cardiac events in congenital long QT syndrome. Heart Rhythm 2004; 1:60.
  80. Heradien MJ, Goosen A, Crotti L, et al. Does pregnancy increase cardiac risk for LQT1 patients with the KCNQ1-A341V mutation? J Am Coll Cardiol 2006; 48:1410.
  81. European Society of Gynecology (ESG), Association for European Paediatric Cardiology (AEPC), German Society for Gender Medicine (DGesGM), et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011; 32:3147.
  82. Oakley GD, McGarry K, Limb DG, Oakley CM. Management of pregnancy in patients with hypertrophic cardiomyopathy. Br Med J 1979; 1:1749.
  83. Pelliccia F, Cianfrocca C, Gaudio C, Reale A. Sudden death during pregnancy in hypertrophic cardiomyopathy. Eur Heart J 1992; 13:421.
  84. van Kasteren YM, Kleinhout J, Smit MA, et al. Hypertrophic cardiomyopathy and pregnancy: a report of three cases. Eur J Obstet Gynecol Reprod Biol 1991; 38:63.
  85. Tanous D, Siu SC, Mason J, et al. B-type natriuretic peptide in pregnant women with heart disease. J Am Coll Cardiol 2010; 56:1247.
  86. Palma EC, Saxenberg V, Vijayaraman P, et al. Histopathological correlation of ablation lesions guided by noncontact mapping in a patient with peripartum cardiomyopathy and ventricular tachycardia. Pacing Clin Electrophysiol 2001; 24:1812.
  87. Page RL. Treatment of arrhythmias during pregnancy. Am Heart J 1995; 130:871.
  88. Ueland K, McAnulty JH, Ueland FR, Metcalfe J. Special considerations in the use of cardiovascular drugs. Clin Obstet Gynecol 1981; 24:809.
  89. VOGEL JH, PRYOR R, BLOUNT SG Jr. DIRECT-CURRENT DEFIBRILLATION DURING PREGNANCY. JAMA 1965; 193:970.
  90. Schroeder JS, Harrison DC. Repeated cardioversion during pregnancy. Treatment of refractory paroxysmal atrial tachycardia during 3 successive pregnancies. Am J Cardiol 1971; 27:445.
  91. Lee RV, Rodgers BD, White LM, Harvey RC. Cardiopulmonary resuscitation of pregnant women. Am J Med 1986; 81:311.
  92. Hubbard WN, Jenkins BA, Ward DE. Persistent atrial tachycardia in pregnancy. Br Med J (Clin Res Ed) 1983; 287:327.
  93. Russell RO Jr. Paroxysmal ventricular tachycardia associated with pregnancy. Ala J Med Sci 1969; 6:111.
  94. Wang YC, Chen CH, Su HY, Yu MH. The impact of maternal cardioversion on fetal haemodynamics. Eur J Obstet Gynecol Reprod Biol 2006; 126:268.
  95. DeSilva RA, Graboys TB, Podrid PJ, Lown B. Cardioversion and defibrillation. Am Heart J 1980; 100:881.
  96. Barnes EJ, Eben F, Patterson D. Direct current cardioversion during pregnancy should be performed with facilities available for fetal monitoring and emergency caesarean section. BJOG 2002; 109:1406.
  97. Magee LA, Downar E, Sermer M, et al. Pregnancy outcome after gestational exposure to amiodarone in Canada. Am J Obstet Gynecol 1995; 172:1307.
  98. Connaughton M, Jenkins BS. Successful use of flecainide to treat new onset maternal ventricular tachycardia in pregnancy. Br Heart J 1994; 72:297.
  99. Hill LM, Malkasian GD Jr. The use of quinidine sulfate throughout pregnancy. Obstet Gynecol 1979; 54:366.
  100. Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. The Cardiac Arrhythmia Suppression Trial (CAST) Investigators. N Engl J Med 1989; 321:406.
  101. Natale A, Davidson T, Geiger MJ, Newby K. Implantable cardioverter-defibrillators and pregnancy: a safe combination? Circulation 1997; 96:2808.
  102. Piper JM, Berkus M, Ridgway LE 3rd. Pregnancy complicated by chronic cardiomyopathy and an automatic implantable cardioverter defibrillator. Am J Obstet Gynecol 1992; 167:506.
  103. Miyoshi T, Kamiya CA, Katsuragi S, et al. Safety and efficacy of implantable cardioverter-defibrillator during pregnancy and after delivery. Circ J 2013; 77:1166.
  104. Abello M, Peinado R, Merino JL, et al. Cardioverter defibrillator implantation in a pregnant woman guided with transesophageal echocardiography. Pacing Clin Electrophysiol 2003; 26:1913.
  105. Jordaens LJ, Vandenbogaerde JF, Van de Bruaene P, De Buyzere M. Transesophageal echocardiography for insertion of a physiological pacemaker in early pregnancy. Pacing Clin Electrophysiol 1990; 13:955.
  106. Lau CP, Lee CP, Wong CK, et al. Rate responsive pacing with a minute ventilation sensing pacemaker during pregnancy and delivery. Pacing Clin Electrophysiol 1990; 13:158.
  107. Coggins DL, Lee RJ, Sweeney J, et al. Radiofrequency catheter ablation as a cure for idiopathic tachycardia of both left and right ventricular origin. J Am Coll Cardiol 1994; 23:1333.
  108. Klein LS, Shih HT, Hackett FK, et al. Radiofrequency catheter ablation of ventricular tachycardia in patients without structural heart disease. Circulation 1992; 85:1666.
  109. Calkins H, Kalbfleisch SJ, el-Atassi R, et al. Relation between efficacy of radiofrequency catheter ablation and site of origin of idiopathic ventricular tachycardia. Am J Cardiol 1993; 71:827.
  110. Timmermans C, Rodriguez LM, Crijns HJ, et al. Idiopathic left bundle-branch block-shaped ventricular tachycardia may originate above the pulmonary valve. Circulation 2003; 108:1960.
  111. Rodriguez LM, Smeets JL, Timmermans C, Wellens HJ. Predictors for successful ablation of right- and left-sided idiopathic ventricular tachycardia. Am J Cardiol 1997; 79:309.
  112. Hogarth AJ, Graham LN. Normal heart ventricular tachycardia associated with pregnancy: successful treatment with catheter ablation. Indian Pacing Electrophysiol J 2014; 14:79.
  113. Pagad SV, Barmade AB, Toal SC, et al. 'Rescue' radiofrequency ablation for atrial tachycardia presenting as cardiomyopathy in pregnancy. Indian Heart J 2004; 56:245.
  114. Bongiorni MG, Di Cori A, Soldati E, et al. Radiofrequency catheter ablation of atrioventricular nodal reciprocating tachycardia using intracardiac echocardiography in pregnancy. Europace 2008; 10:1018.
  115. Risius T, Mortensen K, Meinertz T, Willems S. Cluster of multiple atrial tachycardias limited to pregnancy after radiofrequency ablation following senning operation. Int J Cardiol 2008; 123:e48.
  116. Kanjwal Y, Kosinski D, Kanj M, et al. Successful radiofrequency catheter ablation of left lateral accessory pathway using transseptal approach during pregnancy. J Interv Card Electrophysiol 2005; 13:239.
  117. Bombelli F, Lagona F, Salvati A, et al. Radiofrequency catheter ablation in drug refractory maternal supraventricular tachycardias in advanced pregnancy. Obstet Gynecol 2003; 102:1171.
  118. Domínguez A, Iturralde P, Hermosillo AG, et al. Successful radiofrequency ablation of an accessory pathway during pregnancy. Pacing Clin Electrophysiol 1999; 22:131.
  119. Berruezo A, Díez GR, Berne P, et al. Low exposure radiation with conventional guided radiofrequency catheter ablation in pregnant women. Pacing Clin Electrophysiol 2007; 30:1299.
  120. Szumowski L, Szufladowicz E, Orczykowski M, et al. Ablation of severe drug-resistant tachyarrhythmia during pregnancy. J Cardiovasc Electrophysiol 2010; 21:877.
  121. Damilakis J, Theocharopoulos N, Perisinakis K, et al. Conceptus radiation dose and risk from cardiac catheter ablation procedures. Circulation 2001; 104:893.
  122. Leung CY, Brodsky MA. Cardiac arrhythmias and pregnancy. In: Cardiac problems in pregnancy, 3rd ed, Elkayam U, Gleicher N (Eds), Wiley-Liss, New York 1998. p.155.
  123. Briggs GC, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation, Lippincott Williams & Wilkins, Philadelphia 2005.