Atrial fibrillation pregnancy


 * Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.

Overview
The presence of atrial fibrillation is rare in pregnancy and has an identifiable underlying etiology such as mitral stenosis, congenital heart disease, or hyperthyroidism. Digoxin, beta blocker or non-dihydropyridine CCB may be used to control the ventricular rate. Quinidine has been shown to be safe in pregnancy and remains the drug of choice for pharmacological cardioversion of AF in pregnancy. In cases of hemodynamic instability, direct-current cardioversion may be performed without fetal damage.

==ACCF/AHA/HRS 2011 Guidelines- Pregnancy (DO NOT EDIT) == {{cquote|

Class I
1. Digoxin, a beta blocker, or a non dihydropyridine calcium channel antagonist is recommended to control the rate of ventricular response in pregnant patients with AF. (Level of Evidence: C)

2. Direct-current cardioversion is recommended in pregnant patients who become hemodynamically unstable due to AF. (Level of Evidence: C)

3. Protection against thromboembolism is recommended throughout pregnancy for all patients with AF (except those with lone AF and/or low thromboembolic risk). Therapy (anticoagulant or aspirin) should be chosen according to the stage of pregnancy. (Level of Evidence: C)

Class IIb
1. Administration of heparin may be considered during the first trimester and last month of pregnancy for patients with AF and risk factors for thromboembolism. Unfractionated heparin may be administered either by continuous intravenous infusion in a dose sufficient to prolong the activated partial thromboplastin time to 1.5 to 2 times the control value or by intermittent subcutaneous injection in a dose of 10 000 to 20 000 units every 12 h, adjusted to prolong the mid-interval (6 h after injection) activated partial thromboplastin time to 1.5 times control. (Level of Evidence: B)

2. Despite the limited data available, subcutaneous administration of low molecular weight heparin may be considered during the first trimester and last month of pregnancy for patients with AF and risk factors for thromboembolism. (Level of Evidence: C)

3. Administration of an oral anticoagulant may be considered during the second trimester for pregnant patients with AF at high thromboembolic risk. (Level of Evidence: C)

4. Administration of quinidine or procainamide may be considered to achieve pharmacological cardioversion in hemodynamically stable patients who develop AF during pregnancy. (Level of Evidence: C)}}

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Guideline Resources

 * ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation


 * 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation


 * ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter