Management and Clinical Outcomes of Cardiac Arrhythmias in Pregnancy: A Prospective Study from Peshawar, Pakistan
DOI:
https://doi.org/10.62497/irjgp.170Keywords:
Arrhythmias, pregnancy, maternal health, fetal health, hypertensive disorders, management strategies.Abstract
Background
Cardiac arrhythmias are common during pregnancy and pose significant risks to both maternal and fetal health, necessitating a thorough understanding of their management and outcomes.
Objective
This study aimed to evaluate the types, causes, management strategies, and clinical outcomes of arrhythmias in pregnant women to inform better treatment approaches.
Methodology
A prospective observational study was conducted from January to December 2023. A total of 246 pregnant women diagnosed with arrhythmias were included. We gathered information on demographics, pre-existing diseases, clinical presentations, kinds of arrhythmias, underlying causes, treatment approaches, and outcomes for both the mother and the fetus. Descriptive statistics, logistic regression analysis to determine the factors impacting maternal outcomes, and t-tests to evaluate differences in continuous variables were used in the statistical study. Statistical significance was defined as a p-value of less than 0.05.
Results
The subjects' mean gestational age at the diagnosis of arrhythmia was 22.31 ± 6.84 weeks, and their mean age was 29.57 ± 5.2 years. The most prevalent arrhythmia was atrial fibrillation (34.15%), which was followed by ventricular tachycardia (15.45%) and atrial flutter (19.11%). The most frequent underlying cause was hypertensive disorders (25.20%). Beta-blockers (39.84%), electrical cardioversion (14.63%), and pacemaker implantation (8.94%) were all part of the treatment. According to a logistic regression study, maternal outcomes such as preterm delivery, intrauterine growth restriction, and miscarriage were substantially correlated with primiparity, hypertension, and beta-blocker usage (p < 0.05).
Conclusion
Pregnancy-related arrhythmias are linked to serious problems for both the mother and the fetus, and better results depend on early detection and effective treatment
References
Gowda RM, Khan IA, Mehta NJ, Vasavada BC, Sacchi TJ. Cardiac arrhythmias in pregnancy: clinical and therapeutic considerations. International journal of cardiology. 2003 Apr 1;88(2-3):129-33. https://doi.org/10.1016/S0167-5273(02)00601-0.
Ramlakhan KP, Johnson MR, Roos-Hesselink JW. Pregnancy and cardiovascular disease. Nature Reviews Cardiology. 2020 Nov;17(11):718-31. https://doi.org/10.1038/s41569-020-0390-z.
Ferrero S, Colombo BM, Ragni N. Maternal arrhythmias during pregnancy. Archives of gynecology and obstetrics. 2004 May;269:244-53. https://doi.org/10.1007/s00404-002-0461-x.
Ali S, Raza MA, Fazal S, Ahmad RT, Fatima M, Shahid A, Khatoon F. Exploring the association between passive exposure to household smoking and frequency of recurrent wheezing in children. Journal of Health, Wellness and Community Research. 2025 May 31:e308-. https://doi.org/10.61919/wj7bc393.
Ali S, e Rubab T, Mushtaq W. Investigating the Role of Early Nutritional Interventions in Shaping Long-term Pediatric Health Outcomes: A Multidisciplinary Approach to Growth and Development. Journal of Health, Wellness, and Community Research. 2025 Apr 27:e136-. https://doi.org/10.61919/7han6v98
Nagpal AK, Pundkar A, Singh A, Gadkari C. Cardiac arrhythmias and their management: An in-depth review of current practices and emerging therapies. Cureus. 2024 Aug 9;16(8). DOI: 10.7759/cureus.66549. https://www.cureus.com/articles/283186-cardiac-arrhythmias-and-their-management-an-in-depth-review-of-current-practices-and-emerging-therapies#!/
Senarath S, Nanayakkara P, Beale AL, Watts M, Kaye DM, Nanayakkara S. Diagnosis and management of arrhythmias in pregnancy. EP Europace. 2022 Jul 1;24(7):1041-51. https://doi.org/10.1093/europace/euab297.
Kodogo V, Azibani F, Sliwa K. Role of pregnancy hormones and hormonal interaction on the maternal cardiovascular system: a literature review. Clinical Research in Cardiology. 2019 Aug 1;108:831-46. https://doi.org/10.1007/s00392-019-01441-x.
Enriquez AD, Economy KE, Tedrow UB. Contemporary management of arrhythmias during pregnancy. Circulation: Arrhythmia and Electrophysiology. 2014 Oct;7(5):961-7. https://doi.org/10.1161/CIRCEP.114.001517.
Conti E, Cascio ND, Paluan P, Racca G, Longhitano Y, Savioli G, Tesauro M, Leo R, Racca F, Zanza C. Pregnancy Arrhythmias: Management in the Emergency Department and Critical Care. Journal of Clinical Medicine. 2024 Feb 15;13(4):1095. https://doi.org/10.3390/jcm13041095.
Bett GC. Hormones and sex differences: changes in cardiac electrophysiology with pregnancy. Clinical Science. 2016 May 1;130(10):747-59. https://doi.org/10.1042/CS20150710.
Nanna M, Stergiopoulos K. Pregnancy complicated by valvular heart disease: an update. Journal of the American Heart Association. 2014 Jun 5;3(3):e000712. https://doi.org/10.1161/JAHA.113.000712.
Rehman Z, Hamid M, Khan A, GUL S, ALI S, AHMAD I, ULLAH S. Frequency Of Clinical Syndromes in Children with Congenital Heart Defects Admitted at Tertiary Care Hospital. Biological and Clinical Sciences Research Journal. 2024;2024:1026.
Tamirisa KP, Dye C, Bond RM, Hollier LM, Marinescu K, Vaseghi M, Russo AM, Gulati M, Volgman AS. Arrhythmias and heart failure in pregnancy: a dialogue on multidisciplinary collaboration. Journal of cardiovascular development and disease. 2022 Jun 24;9(7):199. https://doi.org/10.3390/jcdd9070199.
Nagpal AK, Pundkar A, Singh A, Gadkari C. Cardiac Arrhythmias and Their Management: An In-Depth Review of Current Practices and Emerging Therapies. Cureus. 2024 Aug 9;16(8):e66549. doi: 10.7759/cureus.66549.
Adamson DL, Nelson-Piercy C. Managing palpitations and arrhythmias during pregnancy. Postgraduate medical journal. 2008 Feb;84(988):66-72. https://doi.org/10.1136/hrt.2006.098822.
Haq FU, Siraj A, Ameer MA, Hamid T, Rahman M, Khan S, Khan S, Masud S. Comparative review of drugs used in diabetes mellitus—new and old. Journal of diabetes mellitus. 2021 Sep 13;11(4):115-31.
Costa B, Gouveia MJ, Vale N. Safety and Efficacy of Antiviral Drugs and Vaccines in Pregnant Women: Insights from Physiologically Based Pharmacokinetic Modeling and Integration of Viral Infection Dynamics. Vaccines (Basel). 2024 Jul 16;12(7):782. doi: 10.3390/vaccines12070782.
Mehta LS, Warnes CA, Bradley E, Burton T, Economy K, Mehran R, Safdar B, Sharma G, Wood M, Valente AM, Volgman AS. Cardiovascular considerations in caring for pregnant patients: a scientific statement from the American Heart Association. Circulation. 2020 Jun 9;141(23):e884-903. https://doi.org/10.1161/CIR.0000000000000772.
Chokesuwattanaskul R, Thongprayoon C, Bathini T, O’Corragain OA, Sharma K, Prechawat S, Ungprasert P, Watthanasuntorn K, Pachariyanon P, Cheungpasitporn W. Incidence of atrial fibrillation in pregnancy and clinical significance: A meta-analysis. Advances in Medical Sciences. 2019 Sep 1;64(2):415-22. https://doi.org/10.1016/j.advms.2019.07.003.
Park Y, Cho GJ, Roh SY, Na JO, Oh MJ. Increased cardiac arrhythmia after pregnancy‐induced hypertension: a South Korean Nationwide Database Study. Journal of the American Heart Association. 2022 Jan 18;11(2):e023013. https://doi.org/10.1161/JAHA.121.023013.
Li Y, Liang M. Heart Failure With Comorbidities. Cardiology Discovery. 2025:10-97. https://journals.lww.com/cd/fulltext/9900/heart_failure_with_comorbidities.109.aspx.
Ali S, Shah MA, Khan MH, Shah ZA, Waheed A, Ahmad A, Tahir H, Fatima K, Khan BM, Khan NU, Shehzad M. Duchenne Muscular Dystrophy: An Atypical Adult Presentation and Comprehensive Literature Review with Management Recommendations. Biotechnology Journal International. 2025 May 5;29(3):28-60. https://doi.org/10.9734/bji/2025/v29i3776.
Ahmad S, Hussain S, Ali S, Shah WA, Riaz A, Qazi SA, Haider K, Hussain A, Ahmed M, Hassan MA, Ullah B. Infectious causes of acute Meningoencephalitis syndrome in children: Insights from a tertiary care hospital in Pakistan. Mathews Journal of Pediatrics. 2025 Apr 16;10(1):1-1. https://doi.org/10.30654/MJP.10038.
NABI S, ALI S, KHAN AZ, KHAN MN, KUMARI G. Anemia and Bone Marrow Suppression after Intra-Arterial Chemotherapy in Children with Retinoblastoma. Pakistan Journal of Medical & Health Sciences. 2025 May 5;19(4):13-8.
MacIntyre C, Iwuala C, Parkash R. Cardiac arrhythmias and pregnancy. Current Treatment Options in Cardiovascular Medicine. 2018 Aug;20:1-3. https://doi.org/10.1007/s11936-018-0660-9.
Purtell K, Roepke TK, Abbott GW. Cardiac arrhythmia and thyroid dysfunction: a novel genetic link. The international journal of biochemistry & cell biology. 2010 Nov 1;42(11):1767-70. https://doi.org/10.1016/j.biocel.2010.07.013.
Tamirisa KP, Elkayam U, Briller JE, Mason PK, Pillarisetti J, Merchant FM, Patel H, Lakkireddy DR, Russo AM, Volgman AS, Vaseghi M. Arrhythmias in pregnancy. Clinical Electrophysiology. 2022 Jan 1;8(1):120-35. https://doi.org/10.1016/j.jacep.2021.10.004.
Ramlakhan KP, Kauling RM, Schenkelaars N, Segers D, Yap SC, Post MC, Cornette J, Roos-Hesselink JW. Supraventricular arrhythmia in pregnancy. Heart. 2022 Nov 1;108(21):1674-81. https://doi.org/10.1136/heartjnl-2021-320451.
Henry D, Gonzalez JM, Harris IS, Sparks TN, Killion M, Thiet MP, Bianco K. Maternal arrhythmia and perinatal outcomes. Journal of Perinatology. 2016 Oct;36(10):823-7. https://doi.org/10.1038/jp.2016.90.
Lane-Cordova AD, Khan SS, Grobman WA, Greenland P, Shah SJ. Long-term cardiovascular risks associated with adverse pregnancy outcomes: JACC review topic of the week. Journal of the American College of Cardiology. 2019 Apr 30;73(16):2106-16. https://doi.org/10.1016/j.jacc.2018.12.092
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