TY - JOUR
T1 - The Challenge of Managing Atrial Fibrillation during Pregnancy
AU - Lucà, Fabiana
AU - Oliva, Fabrizio
AU - Abrignani, Maurizio Giuseppe
AU - Russo, Maria Giovanna
AU - Parrini, Iris
AU - Cornara, Stefano
AU - Ceravolo, Roberto
AU - Rao, Carmelo Massimiliano
AU - Favilli, Silvia
AU - Pozzi, Andrea
AU - Giubilato, Simona
AU - Di Fusco, Stefania Angela
AU - Sarubbi, Berardo
AU - Calvanese, Raimondo
AU - Chieffo, Alaide
AU - Gelsomino, Sandro
AU - Riccio, Carmine
AU - Grimaldi, Massimo
AU - Colivicchi, Furio
AU - Gulizia, Michele Massimo
AU - ANMCO
AU - Arrhythmias Working Groups
AU - Management and Quality Working Group
AU - Pediatric Cardiology Working Group
N1 - Funding Information:
The authors thank Prof Carol Wintheringham for her English editing.
Publisher Copyright:
Copyright: © 2023 The Author(s)
PY - 2023/10/1
Y1 - 2023/10/1
N2 - The incidence of atrial fibrillation (AF) during pregnancy increases with maternal age and with the presence of structural heart disorders. Early diagnosis and prompt therapy can considerably reduce the risk of thromboembolism. The therapeutic approach to AF during pregnancy is particularly challenging, and the maternal and fetal risks associated with the use of antiarrhythmic and anticoagulant drugs must be carefully evaluated. Moreover, the currently used thromboembolic risk scores have yet to be validated for the prediction of stroke during pregnancy. At present, electrical cardioversion is considered to be the safest and most effective strategy in women with hemodynamic instability. Beta-selective blockers are also recommended as the first choice for rate control. Antiarrhythmic drugs such as flecainide, propafenone and sotalol should be considered for rhythm control if atrioventricular nodal-blocking drugs fail. AF catheter ablation is currently not recommended during pregnancy. Overall, the therapeutic strategy for AF in pregnancy must be carefully assessed and should take into consideration the advantages and drawbacks of each aspect. A multidisciplinary approach with a “Pregnancy-Heart Team” appears to improve the management and outcome of these patients. However, further studies are needed to identify the most appropriate therapeutic strategies for AF in pregnancy.
AB - The incidence of atrial fibrillation (AF) during pregnancy increases with maternal age and with the presence of structural heart disorders. Early diagnosis and prompt therapy can considerably reduce the risk of thromboembolism. The therapeutic approach to AF during pregnancy is particularly challenging, and the maternal and fetal risks associated with the use of antiarrhythmic and anticoagulant drugs must be carefully evaluated. Moreover, the currently used thromboembolic risk scores have yet to be validated for the prediction of stroke during pregnancy. At present, electrical cardioversion is considered to be the safest and most effective strategy in women with hemodynamic instability. Beta-selective blockers are also recommended as the first choice for rate control. Antiarrhythmic drugs such as flecainide, propafenone and sotalol should be considered for rhythm control if atrioventricular nodal-blocking drugs fail. AF catheter ablation is currently not recommended during pregnancy. Overall, the therapeutic strategy for AF in pregnancy must be carefully assessed and should take into consideration the advantages and drawbacks of each aspect. A multidisciplinary approach with a “Pregnancy-Heart Team” appears to improve the management and outcome of these patients. However, further studies are needed to identify the most appropriate therapeutic strategies for AF in pregnancy.
KW - antiarrhythmic drugs (AADs)
KW - anticoagulants
KW - atrial fibrillation (AF)
KW - Pregnancy Heart Team
KW - pregnancy
KW - electrical cardioversion (ECV)
U2 - 10.31083/j.rcm2410279
DO - 10.31083/j.rcm2410279
M3 - (Systematic) Review article
SN - 1530-6550
VL - 24
JO - Reviews in Cardiovascular Medicine
JF - Reviews in Cardiovascular Medicine
IS - 10
M1 - 279
ER -