Management of Arrhythmias During Pregnancy Consensus Statement Emphasizes Shared Decision-Making

The Heart Rhythm Society releases comprehensive guidance for managing arrhythmias in the pregnant patient and fetus

New Orleans, LA, May 19, 2023 – Today, the Heart Rhythm Society (HRS) released a new expert consensus statement on the management of cardiac arrhythmias during pregnancy. The 2023 HRS Expert Consensus Statement on the Management of Arrhythmias During Pregnancy is a comprehensive resource with practical guidance on the optimal management of arrhythmias in pregnant patients and in fetuses.

Fortunately, the most common arrhythmias seen in pregnant patients are generally benign and generally resolve spontaneously after delivery, yet pregnancy is known to trigger sustained arrhythmia especially in patients with a preexisting substrate. The tendency for arrhythmias to arise during pregnancy is multifactorial and thought to be related to a combination of the hemodynamic, hormonal, and autonomic milieu changes that occur during pregnancy.

Atrial fibrillation is increasingly becoming the most common newly diagnosed sustained arrhythmia during pregnancy. Some treatment decisions for atrial fibrillation―such as rate vs rhythm control strategies―are based on the same considerations for nonpregnant patients (e.g., hemodynamic tolerance and underlying substrate). Whereas decisions for other therapies, like anticoagulation, have considerations specific to the pregnant patient and should involve consultation among multiple specialties ranging from cardiology/electrophysiology to maternal- fetal medicine and neonatology to optimize outcomes for both the mother and the fetus/newborn.

"Managing arrhythmias in pregnant patients requires a multidisciplinary care team approach because both the mother and the fetus can be affected," said Jose Joglar, MD, FHRS at the University of Texas Southwestern Medical Center, and Chair of the consensus statement. "Throughout the pregnancy, delivery, and postnatal period it is vital that the patient and care team engage in shared decision-making discussions that consider the risks and benefits of treatment vs no treatment and the reflect each patient’s individual personal preferences."

The expert consensus statement provides guidance for electrophysiologists, cardiologists, and other health care professionals that can be applied worldwide to optimize care and improve outcomes for pregnant patients. The document includes dedicated sections on:

• General concepts related to arrhythmias in both the patient and the fetus during pregnancy
• Optimal approaches to diagnosis and evaluation of arrhythmias during pregnancy
• Approaches for invasive and noninvasive treatments of arrhythmias in pregnant patients
• Disease- and patient-specific considerations when risk stratifying, diagnosing, and treating arrhythmias in pregnant patients
• Management of fetal arrhythmias

The writing committee developed the recommendations taking into consideration the health benefits, side effects, and risks to both the pregnant patient and fetus. The recommendations reflect the current evidence and standards of care; however, the authors recognize that the availability of resources, technology, and health care delivery logistics vary in different parts of the world. "Some procedures are better performed, and some disease states are better managed, in settings where there is specific expertise," said Jose Joglar, MD, FHRS.

The consensus statement is a result of an international collaboration between recognized experts across the fields of cardiac electrophysiology, cardiology, pediatric electrophysiology and cardiology, gynecology, maternal-fetal medicine, and obstetrics. The consensus statement was developed in collaboration with and endorsed by the American College of Cardiology, the American College of Obstetricians and Gynecologists, the American Heart Association, the Asia Pacific Heart Rhythm Society, the European Heart Rhythm Association, the Latin American Heart Rhythm Society, the Pediatric and Congenital Electrophysiology Society, and the Society for Maternal-Fetal Medicine.

The consensus statement will be published in Heart Rhythm and its release will coincide with a session at Heart Rhythm 2023 in New Orleans―a premier event gathering heart rhythm professionals from around the world to advance the field of electrophysiology and improve patient outcomes through the exchange of groundbreaking science, innovative technologies, and life-saving therapies.

Additional Resources

• After May 19, 2023, view the manuscript online in Heart Rhythm
• The document will be presented at Heart Rhythm 2023 during the session "HRS Expert Consensus Statement on the Management of Arrhythmias During Pregnancy: A Case- Based Discussion of Recommendations" on May 19, 2023 at 5:00 pm CT
• The consensus statement was developed in accordance with HRS Clinical Document Development Methodology Manual and Policies

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