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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