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Background
The goal of this study was to determine the prevalence of atrial fibrillation and atrial flutter (AF) in pregnant women and to examine the impact of AF on maternal and fetal outcomes.
Methods and Results
Between January 1, 2003 and December 31, 2013, there were 264 730 qualifying pregnancies (in 210 356 women) in the Kaiser Permanente S...
Context in source publication
Context 1
... 45 pregnancies in 45 women (17.0 per 100 000 pregnancies; 21.4 per 100 000 women), AF was first diagnosed during pregnancy or during the 6-month postpartum period. Table 1 lists the baseline characteristics of the study population. The mean age of pregnant women with AF was 32.8AE5.2 ...
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Citations
... This supports the results of our multivariate regression, which showed Afib to be an independent predictor of VT among PPCM patients. Recent research has also found Afib to be linked to increased mortality among pregnant women [16]. The prevalence and severity of outcomes associated with Afib call for further investigation into the role it plays in the development of VT in PPCM and its influence on outcomes in these patients. ...
Introduction
The purpose of this study was to determine the prevalence of ventricular tachycardia (VT) among patients admitted with peripartum cardiomyopathy (PPCM) as well as to analyze the independent association of VT with in-hospital outcomes among PPCM patients.
Methods
Data were obtained from the National Inpatient Sample from January 2016 to December 2019. We assessed predictors of VT in patients admitted with PPCM. We also assessed the independent association of VT with clinical outcomes among patients admitted with PPCM.
Results
From 2016 to 2019, 4730 patients with PPCM were reported to the national inpatient sample database, 309 of which developed VT (6.5%). Using multivariate analysis, we found predictors of VT to include patient characteristics and factors such as age (adjusted OR (aOR)=1.020, p=0.023), chronic kidney disease (aOR=1.440, p=0.048), coagulopathy (aOR=1.964, p=0.006), and atrial fibrillation (aOR=3.965, p<0.001). Conversely, pre-eclampsia was significantly associated with a decreased risk of VT in PPCM patients (aOR=0.218, p=0.001).
Conclusion
In a large cohort of patients admitted with peripartum cardiomyopathy, we found the prevalence of VT to be 6.5%. Risk factors for VT in this patient population included conditions such as coagulopathy and atrial fibrillation.
... Роль вікових та гендерних особливостей у розвитку ФП. Аналіз робіт про статево-специфічні особливості виявив, що раннє настання менархе у віці від 7 до 11 років (або більш пізнє у віці від 13 до 18 років) було пов'язане з вищим ризиком виникнення епізодів ФП порівняно з менархе у віці 12 років [5,17,33]. Найнижчий ризик ФП спостерігався у жінок, які народили 1 або 2 живих дітей. Жінки, у яких не було дітей, мали вищий ризик розвитку ФП. ...
Annotation. Atrial fibrillation is a polyetiological disease caused not only by the natural aging of the population, but also by chronic cardiovascular diseases and the influence of various risk factors. That is why the purpose of this review was to highlight current and modern views on etiological factors that play a significant role in the development of atrial fibrillation. The analysis of scientific articles and materials from the scientometric databases PubMed, Web of Science, Google Scholar, Crossref, WorldCat was carried out. Demonstrated morphological (enlargement and fibrosis of the left atrium, more massive deposition of calcium in the subendothelial layer, and in rare cases, the development of isolated atrial amyloidosis) and electrophysiological changes (reduction of mitochondrial Ca2+ content, shortening of the effective refractory period, impaired repolarization) of the atria of the heart at autopsy patients with atrial fibrillation and established risk factors for the development of this pathology. Morphological signs of atrial myocardium remodeling in patients with atrial fibrillation are also indicated. In addition to the most common risk factors, namely: age, arterial hypertension, heart failure, coronary heart disease, diabetes, obesity and alcohol abuse, the following are highlighted in recent publications: narcotic substances (methamphetamine, cocaine, cannabis), race belonging to Caucasians, sex-specific features (female gender and fluctuations in estrogen levels), genetic predisposition and hyperaldosteronism against the background of undifferentiated connective tissue dysplasia. Optimal and timely treatment aimed at the above-mentioned etiological factors will reduce the risk of developing this disease and improve the quality of life of patients.
... Though less well documented compared to the general population, obesity (BMI > 30) has also been linked to a higher risk of clinically significant AF in both young women and well as pregnant women [73]. In a study of 113 pregnancies across a cohort of 93 women, obesity (BMI > 30) was associated with a higher risk of clinically significant recurrent AF (odds ratio of 3.8, p-value 0.048) [74]. ...
Postpartum atrial fibrillation is an uncommon but increasingly prevalent tachyarrhythmia that merits special management considerations with regards to the safety and efficacy of anticoagulation, rate and rhythm control as well as drug exposure to infants throughout breastfeeding. In this state-of-the-art review, we examine the demographics of postpartum atrial fibrillation with its associated risk factors, describe the safety of commonly used atrial fibrillation therapies, and discuss important considerations for women considering subsequent pregnancies.
... Symptoms of IST encompass palpitations, chest discomfort, fatigue, dizziness, and reduced exercise tolerance. Notably, published case reports suggest that IST is generally well-tolerated without adverse maternal or fetal outcomes [102,103]. ...
Pregnancy is closely associated with an elevated risk of arrhythmias, constituting the predominant cardiovascular complication during this period. Pregnancy may induce the exacerbation of previously controlled arrhythmias and, in some instances, arrhythmias may present for the first time in pregnancy. The most important proarrhythmic mechanisms during pregnancy are the atrial and ventricular stretching, coupled with increased sympathetic activity. Notably, arrhythmias, particularly those originating in the ventricles, heighten the likelihood of syncope, increasing the potential for sudden cardiac death. The effective management of arrhythmias during the peripartum period requires a comprehensive, multidisciplinary approach from the prepartum to the postpartum period. The administration of antiarrhythmic drugs during pregnancy necessitates meticulous attention to potential alterations in pharmacokinetics attributable to maternal physiological changes, as well as the potential for fetal adverse effects. Electric cardioversion is a safe and effective intervention during pregnancy and should be performed immediately in patients with hemodynamic instability. This review discusses the pathophysiology of arrythmias in pregnancy and their management.
... several physiological changes like an increase in cardiac output, heart rate, plasma volume, wall tension along with fluctuating hormonal levels, and reduction in systemic vascular resistance or sometimes due to the use of tocolytics [2]. Risk factors like increased maternal age, white race, male sex, obstructive sleep apnea, obesity, consuming alcohol, endurance sports, family history, and several recognized mutations could trigger the development of lone AF [2,3]. ...
... several physiological changes like an increase in cardiac output, heart rate, plasma volume, wall tension along with fluctuating hormonal levels, and reduction in systemic vascular resistance or sometimes due to the use of tocolytics [2]. Risk factors like increased maternal age, white race, male sex, obstructive sleep apnea, obesity, consuming alcohol, endurance sports, family history, and several recognized mutations could trigger the development of lone AF [2,3]. ...
Atrial fibrillation (AF) is one of the most common arrhythmias and is a rare phenomenon seen in pregnant patients unless there is an underlying cardiopulmonary abnormality. Lone AF in pregnancy is a diagnosis of exclusion. A thorough workup including history, physical examination, imaging, and laboratory workup should be done diligently to exclude cardiopulmonary diseases (like hypertensive heart disease, congenital heart disease, valvular heart disease, asthma or chronic obstructive pulmonary disease, pulmonary embolism, rheumatic heart disease) and non-cardiac diseases (such as hyperthyroidism or electrolyte abnormalities or medications). There are very few case reports and studies published so far on this topic. This case report is on a pregnant patient without any significant past medical history who developed new-onset lone AF without any known cause and was managed with Diltiazem, which resulted in chemical cardioversion of atrial fibrillation with rapid ventricular rate to normal sinus rhythm.
... A recent 2022 study published by the Chronic Hypertension and Pregnancy (CHAP) Trial Consortium in the New England Journal of Medicine helps to further identify blood pressure targets in pregnant women. This multi-center randomized trial studied 2408 pregnant women, separated into two groups-those who received antihypertensive treatment for a target BP of less than 140/90 mmHg (treatment group) and those with a target BP of less than 160/105 mmHg 1st line: beta blockers (except atenolol), alpha methyldopa, and calcium channel blockers [11] 1st line: labetalol and nifedipine 2nd line: hydralazine and methyldopa Also, add low-dose aspirin 81 mg daily from weeks 12 to 28 [18] Goal BP: 12-159/80-109 [131] Hyperlipidemia For TG > 500, omega-3 fatty acids with or without fenofibrate or gemfibrozil during the second trimester [2 •] Gemfibrozil, fenofibrate, and ezetimibe should only be used when the benefits outweigh the risk [11] Statins are contraindicated [132] Acute MI Beta blockers, heparin, clopidogrel, and aspirin (high dose aspirin of 325 mg is indicated until 32 weeks of gestation) [45] Beta blockers, heparin, clopidogrel, and low-dose aspirin [11] Beta blockers, heparin, aspirin, and nitrates [8] PPCM Loop diuretics, beta blockers, hydralazine, nitrates, and digoxin [72] Beta blockers, hydralazine, nitrates, and consider diuretics [11] Beta blockers, hydralazine, nitrates, and diuretics [8] AFib Beta blockers or non-dihydropyridine calcium channel antagonists, and digoxin [84] 1st line: beta blockers and anticoagulation with heparin (vit K antagonists may be used only in the 2nd trimester) 2nd line: digoxin and verapamil [11,109] Beta blockers or calcium channel antagonists and digoxin [86] PE ...
... However, the incidence of neonate admissions to the NICU was higher (10.8%) for patients with atrial fibrillation as opposed to those without (5.1%) [84]. ...
... The AHA recommends that new-onset atrial fibrillation in a pregnant person should be evaluated by a cardiologist [84]. For hemodynamically stable patients, rate control can be achieved with beta blockers, calcium channel blockers, or digoxin [86]. ...
Purpose of review
We review the epidemiology, risk factors, presentation, pathophysiology, diagnosis, peripartum management, and postpartum follow-up of chronic hypertension, hyperlipidemia, acute myocardial infarction, stroke, heart failure, pulmonary embolism, and atrial fibrillation.
Recent findings
We discuss pathophysiology and evidence-based management for chronic hypertension, hyperlipidemia, acute myocardial infarction, stroke, heart failure, pulmonary embolism, and atrial fibrillation.
Summary
It is essential for providers and patients to understand how cardiovascular diseases cause complications in pregnancy and to identify when patients require screening before conception and throughout the pregnancy. While primary care physicians, obstetricians, and cardiologists, should all have a general understanding of cardiovascular diseases during pregnancy, for higher risk patients it is important to create a multi-disciplinary cardio-obstetrics team for preconception planning, and for risk reduction during and after pregnancy. Shared decision-making regarding risks and benefits is crucial to improve maternal morbidity and mortality in the United States.
... They are uncommon, with an approximate rate of 59.3 per 100 000 pregnancies. 18 However, in women with established heart disease, data from the European Registry on Heart Disease in pregnancy demonstrates that AF or AFL may occur in approximately 1.3% of pregnancies. 19 This contrasts with SVT, which is more much common in pregnancy, with an estimated incidence of 1 in 8000 pregnancies. ...
Objective
Direct current cardioversion (DCCV) in pregnancy is rarely required and typically only documented in single case reports or case series. A recent UK confidential enquiry reported on several maternal deaths where appropriate DCCV appeared to have been withheld.
Design
Retrospective cohort study.
Setting
Seventeen UK and Ireland specialist maternity centres.
Sample
Twenty‐seven pregnant women requiring DCCV in pregnancy.
Main outcome measures
Maternal and fetal outcomes following DCCV.
Results
Twenty‐seven women had a total of 29 DCCVs in pregnancy. Of these, 19 (70%) initial presentations were to Emergency Departments and eight (30%) to maternity settings. There were no maternal deaths. Seventeen of the women (63%) had a prior history of heart disease. Median gestation at DCCV was 28 weeks, median gestation at delivery was 35 weeks, with a live birth in all cases. The abnormal heart rhythms documented at the first cardioversion were atrial fibrillation in 12/27 (44%) cases, atrial flutter in 8/27 (30%), supraventricular tachycardia in 5/27 (19%) and atrial tachycardia in 2/27 (7%). Fetal monitoring was undertaken following DCCV on 14/29 (48%) occasions (10 of 19 (53%) at ≥26 weeks) and on 2/29 (7%) occasions, urgent delivery was required post DCCV.
Conclusions
Direct current cardioversion in pregnancy is rarely required but should be undertaken when clinically indicated according to standard algorithms to optimise maternal wellbeing. Once the woman is stable post DCCV, gestation‐relevant fetal monitoring should be undertaken. Maternity units should develop multidisciplinary processes to ensure pregnant women receive the same standard of care as their non‐pregnant counterparts.
... Women who had known AF had a recurrence in 39.2% of pregnancies. As expected, pregnant women with prior structural heart disease had worse maternal outcomes compared to those without structural heart disease after their AF diagnosis [22]. ...
Atrial fibrillation has been described as a global epidemic with a three-fold increase in prevalence in the last 50 years. As the prevalence of atrial fibrillation continues to grow, multiple landmark trials have been designed to determine the best method to treat atrial fibrillation. Initial trials have stated that rate control was not inferior to rhythm control, however, as the efficacy of rhythm control of atrial fibrillation has improved, a benefit in rhythm control has been shown. Because of this trend towards increased rhythm control, more patients have been placed on anti-arrhythmic medications. This paper will review the epidemiology and clinical impact of the utilization of anti-arrhythmic medications. As we enter the era of rhythm control, increased awareness is needed regarding the monitoring and potential adverse events that can occur with these medications. Providers must balance the increased emphasis on rhythm control with the overall clinical impact on their patients due to drug-to-drug interactions and adverse effects that can occur with different co-morbidities. If the clinical momentum towards rhythm control continues, real-world data analysis will be needed to evaluate the clinical impact of the use, risk, and benefits of anti-arrhythmic medications.
... 18,20 Heart failure (HF) was reported in 1.2% of pregnant patients with AF and in 24% of patients with VT (compared with 12% in patients without VT; P¼0.03). 17,20 Higher Caesarean delivery (CD) rates were observed in patients with AF (40%), VT (68%) and SVT (OR¼e1.7). 18,20,23 In population-based studies, AF was associated with a higher incidence of obstetric complications (pre-eclampsia, postpartum haemorrhage, preterm labour, premature rupture of membranes and placental abruption [OR¼e4.4]), ...
... 23 In patients with AF, higher rates of neonatal intensive care unit admission rates (10.8% vs 5.1%, P¼0.003) along with lower birth weight (35% vs 14%; P¼0.02) were recorded. 17,18 In pregnant patients with VT, neonatal death (4.8% vs 0.3% P¼0.01), preterm birth (36% vs 16%, P¼0.001), low birth weight (33% vs 15%, P¼0.001) and Apgar score <7 (25% vs 7.3%, P¼0.001) are described. 20 Stillbirths were eight times more likely (4% vs 0.5%), whereas miscarriage rates were two times higher (16% vs 8%) in patients with LQTS compared with the general population. ...
... One of the most prevalent cardiac arrhythmias is AF. Pregnancy's increased cardiac workload may make AF less tolerable and raise the risk of heart failure (Lee et al., 2016). ...
Aim/Purpose: This paper illustrates the potential of health recommender systems (HRS) to support and enhance maternal care. The study aims to explore the recent implementations of maternal HRS and to discover the challenges of the implementations. Background: The sustainable development goals (SDG) aim to reduce maternal mortality to less than 70 per 100,000 live births by 2030. However, progress is uneven between countries, with primary causes being severe bleeding, infections, high blood pressure, and failed abortions. Regular antenatal care (ANC) visits are crucial for detecting and managing complications, such as hypertensive illnesses, anemia, and gestational diabetes mellitus. Utilizing maternal evaluations during ANC visits can help identify and treat problems early, lowering morbidity and death rates for both mothers and fetuses. Technology-enabled daily health recording can help monitor pregnancy by providing actionable guides to patients and health workers based on patient status. Methodology: A systematic literature review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to identify maternal HRS reported in studies between November 2022 and December 2022. Information was subsequently extracted to understand the potential benefits of maternal HRS. Titles and abstracts of 1,851 studies were screened for the full-text screening, in which two reviewers independently selected articles and systematically extracted data using a predefined extraction form. Contribution: This study adds to the explorations of the challenges of implementing HRS for maternal care. This study also emphasizes the significance of explainability, data-driven methodologies, automation, and the necessity for integration and interoperability in the creation and deployment of health recommendation systems for maternity care. Findings: The majority of maternal HRS use a knowledge-based (constraint-based) ap-proach with more than half of the studies generating recommendations based on rules defined by experts or available guidelines. We also derived four types of interfaces that can be used for delivering recommendations. Moreover, patient health records as data sources can hold data from patients’ or health workers’ input or directly from the measurement devices. Finally, the number of studies in the pilot or demonstration stage is twice that in the sustained stages. We also discovered crucial challenges where the explainability of the methods was needed to ensure trustworthiness, comprehensibility, and effective enhancement of the decision-making process. Automatic data collection was also required to avoid complexity and reduce workload. Other obstacles were also identified where data integration between systems should be established and decent connectivity must be provided so that complete services can be admin-istered. Lastly, sustainable operations would depend on the availability of standards for integration and interoperability as well as sufficient financial sup-port. Recommendations for Practitioners: Developers of maternal HRS should consider including the system in the main healthcare system, providing connectivity, and automation to deliver better service and prevent maternal risks. Regulations should also be established to support the scale-up. Recommendation for Researchers: Further research is needed to do a thorough comparison of the recommendation techniques used in maternal HRS. Researchers are also recommended to explore more on this topic by adding more research questions. Impact on Society: This study highlights the lack of sustainability studies, the potential for scaling up, and the necessity for a comprehensive strategy to integrate the maternal recommender system into the larger maternal healthcare system. Researchers can enhance and improve health recommendation systems for maternity care by focusing on these areas, which will ultimately increase their efficacy and facilitate clinical practice integration. Future Research: Additional research can concentrate on creating and assessing methods to increase the explainability and interpretability of data-driven health recommender systems and integrating automatic measurement into the traditional health recommender system to enhance the anticipated outcome of antenatal care. Comparative research can also be done to assess how well various models or algorithms utilized in these systems function. Future research can also examine creative solutions to address resource, infrastructure, and technological constraints, such as connectivity and automation to help address the shortage of medical personnel in remote areas, as well as define tactics for long-term sustainability and integration into current healthcare systems.
