Supraventricular Tachycardia in Pregnancy

The commonest arrhythmia in women of reproductive age, isparoxysmal supraventricular tachycardia (SVT). We present arare case of SVT who presented for the first time duringpregnancy, who failed to respond to Electricalcardioversion(ECV), but reverted back to sinus rhythm bysecondline pharmacotherapy.PROCEDURE:A 22 year old primigravidapresented at 37weeks in labour withcomplaints of breathlessness and severe palpitations when shewas diagnosed to have supraventricular tachycardia(SVT) onECG and was referred to a tertiary care centre for furthermanagement.Pharmacological cardioversion was attemptedwith intravenous diltiazem, but in vain. Decision was taken forelectrical cardioversion with synchronized DC shocks of 50joules and 100 joules successively, but was not successful too.As a last resort, bolus of intravenous Amiodarone 150 mg wasgiven over 10 minutes followed by infusion at the rate of 24mg per hour(2ml/hr), which finally brought down the heartrate to 98bpm. In view of non-reassuring fetal heart rateobserved on CTG, patient was taken up for an emergencycaesarean section under epidural anaesthesia with grave riskconsent and shifted to ICCU post-operatively.RESULT:Patient delivered a male baby of birth weight 2.35kg. Patienttolerated the surgery well and did not experience any episodesof PSVT throughout the intra-operative period. Postoperativelypatient was managed in consultation with cardiologist.Amiodarone infusion was continued for 24 hours at 24mg/hour. Post-operative period was uneventful, patient was startedon oral anti arrhythmic medications and discharged on thesame.CONCLUSION :Accurate diagnosis, regular follow up and multidisciplinaryapproach during acute episode and during delivery can preventlife threatening risks that might be posed to the mother andfetus in a case of PSVT. Treatment options includenonpharmacological therapy, followed by adenosine and otherdrugs if required, and lastly electrical cardioversion