HEART RHYTHM DISORDERS IN PREGNANCY

The article presents a review of literature data about influence of the most common disorders in heart rhythm on the organism of a pregnant woman and fetus, about peculiarities of management of such patients and about principles of administration of antiarrhythmic drugs. Arrhythmias are seen in 20-40% of pregnant women mostly in the form of supraventricular and ventricular extrasystole; life-threatening malignant rhythm disorders are rather rare and in the absence of any structural changes in the myocardium do not influence the prognosis. Due to the probability of unfavorable influence on fetus, antiarrhythmic drugs are prescribed to pregnant females only for strict indications. Medicinal treatment is required only in case of frequent extrasystoles with hemodynamic disorders, with evident impairment of the quality of life, or when threatening with a transition to more severe arrhythmias. In development of paroxysm of tachycardia with unstable hemodynamics electrical cardioversion is used. For treatment of uncomplicated tachycardia antiarrhythmic drugs are used of B or C category according to FDA (Food and Drug Administration) classification, and only in case of their noneffectiveness amiodarone is administered for live-saving indications. In pregnant females it is possible to use radio frequency ablation or implantable cardioverter defibrillator. In the article the results of clinical observation of a 25-year old pregnant patient with repeated ventricular extrasystole, repeated paroxysms of ventricular tachycardia accompanied by syncopal conditions, are described. Under observation by arrhythmologists of FSBI Almazov North-West Medical Research Center of Ministry of Health of Russia, pregnancy was prolonged to 38 weeks by administration of metoprolol succinate, and ended in vaginal delivery under epidural anesthesia. Clinical observation shows that potentially malignant arrhythmias are not indications for interruption of pregnancy, and minimal antiarrhythmic therapy is sufficient for effective management of such patients.