| Abstract [eng] |
Supraventricular tachycardia is one of the most common arrythmias during pregnancy, ranging from brief palpitations to prolonged episodes that are difficult to treat with medication. Supraventricular tachycardia carries a higher risk of foetal complications; therefore, the possible harm of uncorrected pathology should be assessed, and foetal condition should be monitored. Most antiarrhythmic drugs cross the placental barrier, but data on the safety and efficacy of these drugs are limited due to the lack of clinical trials in pregnant women. The basic principles for the use of drugs in pregnancy are to determine the need for the drug, the urgency of treatment, the presence of structural heart disease, and the risk of harmful effects of the drug on the foetus, according to the trimester of gestation. All antiarrhythmic drugs should be avoided during the first trimester of pregnancy. The first-line method of choice for terminating supraventricular tachycardia paroxysms are vagal manoeuvres. If they are ineffective, adenosine is the first choice, followed by β1 selective (except atenolol) beta-blockers, and digoxin. In case of haemodynamic instability, immediate electrical cardioversion is performed. Preventive medical treatment is given in the presence of severe symptoms or haemodynamic disturbances, after correcting arrhythmia triggers. In patients without Wolff-Parkinson-White syndrome, it is recommended to start treatment with β1 beta-blockers alone, or in combination with digoxin, or with verapamil alone. If these drugs are ineffective, flecainide or propafenone may be prescribed, which are also recommended for pregnant women with Wolf-Parkinson-White syndrome, and without structural or ischaemic heart disease. Fluoroless catheter ablation can be performed from the second trimester when medical therapy is ineffective. In women of childbearing age with recurrent symptomatic tachycardia, catheter ablation is recommended before pregnancy. A review of the literature on the treatment options and challenges of supraventricular tachycardia in pregnancy and an analysis of successful treatment of supraventricular tachycardia in the setting of symptomatic tachycardia episodes in the 29th week of gestation are presented. The patient was treated with β1 beta-blocker and digoxin. Treatment was adjusted according to 24-hour electrocardiogram monitoring data, digoxin blood levels and the patient's well-being. |
