Clinical Significance of Supraventricular Tachycardia During Pregnancy in Healthy Women

Alexandra Bekiaridou; Kristie M Coleman; Nikhil Sharma; Deepika George; Yan Liu; Eugenia Gianos; Stacey Rosen; Jennifer Mieres; Stavros E Mountantonakis

doi:10.1016/j.jacep.2024.03.014

Clinical Significance of Supraventricular Tachycardia During Pregnancy in Healthy Women

JACC Clin Electrophysiol. 2024 Apr 12:S2405-500X(24)00195-6. doi: 10.1016/j.jacep.2024.03.014. Online ahead of print.

Authors

Alexandra Bekiaridou¹, Kristie M Coleman², Nikhil Sharma³, Deepika George⁴, Yan Liu⁴, Eugenia Gianos⁵, Stacey Rosen⁶, Jennifer Mieres⁶, Stavros E Mountantonakis⁷

Affiliations

¹ Northwell Health, New Hyde Park, New York, USA; Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, USA; Feinstein Institute for Medical Research, Manhasset, New York, USA.
² Northwell Health, New Hyde Park, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA; Lenox Hill Hospital, New York, New York, USA. Electronic address: https://twitter.com/keepinrhythm.
³ Northwell Health, New Hyde Park, New York, USA; Feinstein Institute for Medical Research, Manhasset, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA.
⁴ Northwell Health, New Hyde Park, New York, USA; Feinstein Institute for Medical Research, Manhasset, New York, USA.
⁵ Northwell Health, New Hyde Park, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA; Lenox Hill Hospital, New York, New York, USA.
⁶ Northwell Health, New Hyde Park, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA.
⁷ Northwell Health, New Hyde Park, New York, USA; Northwell Cardiovascular Institute, New York, New York, USA; Lenox Hill Hospital, New York, New York, USA. Electronic address: smountanto@northwell.edu.

PMID: 38661600
DOI: 10.1016/j.jacep.2024.03.014

Abstract

Background: Supraventricular tachycardias (SVT) are the most frequently encountered arrhythmias in pregnancy with unclear clinical significance.

Objectives: This study sought to report the prevalence, describe the management, and explore the association between SVT and adverse obstetric outcomes.

Methods: Cohort study of primiparous and multiparous women without history of Cesarean section (CS), and with structurally normal hearts admitted in labor. The study group consisted of women with at least 1 SVT episode during pregnancy, and the control group was randomly selected in a 4:1 ratio.

Results: Of 141,769 women meeting the inclusion criteria, SVT diagnosis was confirmed in 122. A total of 76 (age 33.2 ± 4.8 years) had at least 1 symptomatic and documented episode during pregnancy. In women with a known SVT diagnosis before pregnancy, medical therapy was not associated with a lower risk of SVT recurrence (OR: 1.07; 95% CI: 0.41-2.80). However, catheter ablation before pregnancy was associated with significantly lower risk of SVT recurrence (OR: 0.09; 95% CI: 0.04-0.23). Women with SVT during pregnancy had higher incidence of CS (39.5% vs 27.0%; P = 0.03), and preterm labor (PTL) (30.3% vs 8.6%; P < 0.001). Adjusting for age and parity, SVT during pregnancy was an independent predictor of CS (OR: 1.80; 95% CI: 1.03-3.10), particularly planned CS (OR: 2.89; 95% CI: 1.06-7.89) and PTL (OR: 4.37; 95% CI: 2.30-8.31).

Conclusions: SVT during pregnancy is associated with increased risk for CS and PTL in healthy women. History of SVT should be sought as early as preconception counseling, and a multidisciplinary approach is warranted for both prevention and management of SVT occurrence.

Keywords: Cesarean section; catheter ablation; pregnancy; supraventricular tachycardia.