Download Management of Ventricular Tachycardia with structurally normal

Management of Ventricular Tachycardia
with structurally normal heart in
Pregnancy – A Case Series
Dr Rizwan Ahmed, Specialist Registrar Cardiology, Norfolk and
Norwich University Hospital, Norwich, UK
Dr Leisa Freeman, Consultant Cardiologist, Norfolk and Norwich
University Hospital, Norwich, UK
19 February 2014, CPP, Venice
Patient A
Patient A
Patient A
Patient A
Patient A
Referred to maternal cardiology service during pregnancy
in 2011 – miscarriage.
Pregnant again 2012 – On Propranolol 160 mg OD.
Continued to have palpitations therefore started on
Flecainide – ectopic burden reduced to < 100/24 hours.
Patient symptomatically well.
Birth planning (by a team including Maternal Cardiologist,
Obstetrician, Electrophysiologist and Anaesthetist).
Patient A
Admit as soon as starts contracting
ECG on admission – start cardiac monitoring
Early epidural (avoid pain)
Active second stage to be limited to 45 minutes
If ventricular arrhythmias – IV Flecainide or IV Labetalol;
Cardioversion if haemodynamically unstable.
Patient B
Patient B
Patient B
Admit when contractions start.
Continuous cardiac monitoring not needed but to start if
sustained palpitations.
In case of sustained but tolerated VT in descending order:
1) Adenosine 2) IV Labetalol 3) IV Flecainide
In case of haemodynamic compromise - cardiovert
Dissuaded from water birth. Had normal vaginal delivery.
Healthy baby.
Patient C
Patient C
Patient C
Prognosis good
In event of sustained palpitations for Vaerapamil.
If haemodynamically compromised (unlikely) for DC
Cardioversion.
Caesarean section for obstetric indications – well mum and
child.
VT in pregnancy
What are the symptoms and symptom burden?
Is there previous cardiac history? Previous pregnancies?
Family history of SIDS/SUDS/cardiomyopathy.
Exclude structural cardiac abnormalities.
Assessment and birth planning in a multidisciplinary setting
After birth: Contraception and future pregnancies; EPS +/ablation