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Atrial fibrillation during pregnancy: a 9-month period with limited options

Schwangerschaft und Vorhofflimmern: 9 Monate mit limitierten Möglichkeiten

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Abstract

Pregnancy is a physiological condition with reversible hemodynamic, neurohormonal and coagulation changes to the maternal body during this 9‑month period. The occurrence of atrial fibrillation (AF) is altogether rare among pregnant women, but necessitates immediate treatment und further work-up. Despite numerous pharmacological and invasive therapeutic modalities for AF in non-pregnant patients, very few options are considered safe enough for the fetus and the mother during pregnancy. Commonly used medications such as beta blockers, calcium channel antagonists, antiarrhythmic drugs and anticoagulation therapy must be carefully individualized according to the week of gestation and possible underlying comorbidities of the mother, thus highlighting the importance of an interdisciplinary evaluation by a cardiologist and a gynecologist. The current review summarizes the existing knowledge and treatment options for AF in pregnancy and suggests a simplified algorithm for this clinical constellation.

Zusammenfassung

Die Schwangerschaft ist eine 9‑monatige physiologische Phase, die mit reversiblen hämodynamischen, neurohormonellen und hämostaseologischen Veränderungen des mütterlichen Körpers einhergeht. Vorhofflimmern (VHF) ist zwar insgesamt eine seltene Erkrankung bei schwangeren Frauen, erfordert jedoch eine schnelle Behandlung und weitere Abklärung. Für nichtschwangere Patientinnen stehen zahlreiche medikamentöse und invasive Behandlungsoptionen zur Verfügung; dagegen sind die Möglichkeiten bei schwangeren Frauen hinsichtlich der Sicherheit von Mutter und Fetus stark limitiert. Häufig verwendete Medikamente wie Betablocker, Kalziumkanalblocker, Antiarrhythmika und Antikoagulanzien müssen sehr vorsichtig und individualisiert gegeben werden; zu berücksichtigen sind dabei die aktuelle Schwangerschaftswoche und mögliche Komorbiditäten. Das unterstreicht die Notwendigkeit der interdisziplinären Evaluation durch einen Kardiologen und Gynäkologen. Die vorliegende Übersichtsarbeit fasst den aktuellen Wissensstand und die Behandlungsoptionen bei VHF während der Schwangerschaft zusammen. Des Weiteren wird ein vereinfachter Algorithmus für diese klinische Konstellation präsentiert.

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Authors and Affiliations

  1. Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen, Brusebrinkstraße 20, 58135, Hagen, Germany

    Konstantinos Iliodromitis MD &  Harilaos Bogossian MD

  2. Department of Gynecology, Evangelisches Krankenhaus Hagen, Hagen, Germany

    Jacek Kociszewski MD

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  1. Konstantinos Iliodromitis MD
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  2. Jacek Kociszewski MD
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  3. Harilaos Bogossian MD
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Correspondence to Harilaos Bogossian MD.

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K. Iliodromitis, J. Kociszewski and H. Bogossian declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were performed in accordance with the ethical standards indicated in each case.

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Iliodromitis, K., Kociszewski, J. & Bogossian, H. Atrial fibrillation during pregnancy: a 9-month period with limited options. Herzschr Elektrophys 32, 158–163 (2021). https://doi.org/10.1007/s00399-021-00751-w

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