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Clinical Significance of SVT During Pregnancy in Healthy Women
Quick Takes
- Supraventricular tachycardia (SVT) occurrence during pregnancy is associated with double the risk of Cesarean section and 4 times the risk of preterm labor in primiparous and multiparous women with structurally normal hearts.
- These data support the need for a multidisciplinary approach to acute arrhythmia management and peri-labor planning in pregnant women with SVT.
- History of SVT should be sought and addressed during preconception counseling and should trigger discussion about the risks and benefits of planned elective catheter ablation preconception.
Study Questions:
What is the prevalence, the management, and the association between supraventricular tachycardias (SVTs) and adverse obstetric outcomes?
Methods:
The investigators conducted a 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 ≥1 SVT episode during pregnancy, and the control group was randomly selected in a 4:1 ratio. Outcomes including CS, preterm labor (PTL) (<37 weeks of gestation), and mean length of stay were evaluated between the SVT and the control group. Fetal and maternal mortality, as well as admission to the neonatal intensive care unit, were also reported. Associations between SVT and PTL and CS were tested using multiple logistic regression (modeled separately).
Results:
Of 141,769 women meeting the inclusion criteria, SVT diagnosis was confirmed in 122 patients. A total of 76 (age 33.2 ± 4.8 years) had ≥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 (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.41-2.80). However, catheter ablation before pregnancy was associated with a significantly lower risk of SVT recurrence (OR, 0.09; 95% CI, 0.04-0.23). Women with SVT during pregnancy had a higher incidence of CS (39.5% vs. 27.0%; p = 0.03), and 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:
The authors report that SVT during pregnancy is associated with an increased risk for CS and preterm labor in healthy women.
Perspective:
This cohort study reports that SVT occurrence during pregnancy is associated with double the risk of CS and 4 times the risk of PTL in primiparous and multiparous women with no prior CS and structurally normal hearts. Of note, challenges in acute arrhythmia management and unpredictability of SVT recurrence are likely to drive the decision for planned CS. These data support the need for a multidisciplinary approach to acute arrhythmia management and peri-labor planning in pregnant women with SVT. Furthermore, history of SVT should be sought and addressed during preconception counseling and should trigger discussion about the risks and benefits of planned elective catheter ablation preconception.
Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Cardio-Obstetrics, Pregnancy, Tachycardia, Ventricular
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