Multidisciplinary management on paroxysomal supraventricular tachycardia in pregnancy-balancing maternal hemodynamic stability and fetal safety

Pregnancy is known to be associated with an increased incidence of arrhythmias; more benign forms of arrhythmias, such as premature atrial and ventricular contractions, demonstrate a higher burden during pregnancy compared with prepregnancy. Proarrhythmic mechanisms of pregnancy are presumably related to cardiovascular, autonomic, and hormonal changes. Increased circulating catecholamines , chronotropic effects of relaxin, mechanical effects of atrial stretch, increased ventricular end-diastolic volume caused by intravascular volume expansion, and hormonal and emotional changes all contribute to proarrhythmia . Perhaps the normal but mild hypokalemia of pregnancy or the physiological rise in heart rate serves to arrhythmias. Supraventricular tachycardia (SVT) is a tachyarrhythmia characterized by a heart rate above 120 beats per minute (BPM). Patients with SVT present with the following symptoms:-palpitations, shortness of breath, chest pain, hemodynamic instability, or possibly asymptomatic. The increase in cardiac output and the increase in resting heart rate during pregnancy predispose pregnant women to SVT. The management of SVT in pregnancy, although remarkably similar, varies slightly based on the trimester of pregnancy. Atenolol and verapamil are effective methods of treating SVT, which can be used during the second and third trimesters. Both medications are contraindicated in the first trimester. At the same time, intravenous adenosine can be used in all three trimesters, including labor. Electrical cardioversion is an effective treatment method for hemodynamically unstable or drug-refractory patients, which has proven to be safe in all three trimesters, including labor but can result in pre-term labor in the third trimester. Non-fluoroscopic ablation proved to be the only treatment method that definitively resolved SVT without recurrence.