MANAGING SUPRAVENTRICULAR TACHYCARDIA (SVT) DURING PREGNANCY, LABOR AND DELIVERY

Problem Statement:

Pregnancy introduces physiological changes that can lead to new-onset arrhythmias, with supraventricular tachycardia (SVT) being the most common. When recurrent and resistant to treatment, these arrhythmias pose a significant risk to both the mother and fetus. The complexity lies in managing SVT during pregnancy and postpartum, necessitating a comprehensive approach that considers altered pharmacodynamics, placental drug transfer, and maternal-fetal well-being.

Methods: Case Report.

Results:

A 26-year-old primigravid woman at 35 weeks of gestation, with severe (class III) obesity and no prior history of arrhythmias, presented with a heart rate of 209 beats per minute (bpm). Initial interventions (vagal maneuvers, metoprolol, and adenosine) were unsuccessful. Diltiazem administration by cardiology team successfully converted the heart rate from 200 to normal rate and rhythm.

She was subsequently admitted to labor and delivery for Pitocin induction of labor at 39 weeks gestation and had vaginal delivery with no postpartum hemorrhage. In the immediate postpartum period she had recurrence of SVT, she refused adenosine administration and was successfully managed with parenteral diltiazem administration. Both mother and baby were discharged home in stable condition on postpartum day 2.

Conclusion:

Managing SVT during pregnancy and postpartum is challenging but vital. Multidisciplinary collaboration is crucial while considering physiological changes, maternal-fetal well-being, and potential recurrence. Swift transition to alternative interventions like diltiazem or electric cardioversion, when initial treatments fail, are effective. Non-pharmacological strategies like ablation may offer long-term solutions. Continuous postpartum monitoring is essential, as SVT can reoccur or persist. Educating patients about arrhythmia signs and symptoms is critical for timely care. By refining our approach and empowering patients, we can enhance the well-being of mothers and newborns in complex cases, ultimately improving pregnancy outcomes.

At her postpartum cardiology visit, she had responded well to calcium channel blockers but not to beta-blocker or Adenosine. Her 2-D echocardiogram was normal with preservation of her ejection fraction. Her cardiac computed tomography angiography (CTA) was normal and she had normal electrolytes as well as thyroid function tests.

The authors have no relevant financial disclosures.

Institutional review board (IRB) approval not required because this is a case report.