Janjua Nusrat Batool, Birmani Suhaib Akhtar, McDonagh Thomas, Hameed Abdul, McKernan Matthew
Cavan and Monaghan General Hospital, Co. Cavan. Ireland.
University Hospital, Galway.
Medicine (Baltimore). 2020 Feb;99(7):e19156. doi: 10.1097/MD.0000000000019156.
Atrial fibrillation (AF) is encountered rarely in pregnancy. Management of maternal AF is challenging as it poses a threat to both maternal and fetal well-being.
We report a case of a 35 weeks pregnant woman who presented in emergency with sudden-onset palpitations and mild shortness of breath with no personal/family history of cardiac diseases.
Patient's pulse was irregularly irregular with an average rate of 179 beats per minute. The obstetric examination was normal.
High-sensitive cardiac troponin T (hs-cTnT) was elevated. The 12 lead electrocardiogram (ECG) confirmed AF. The obstetric ultrasound, electronic fetal heart rate (EFHR) trace, and maternal echocardiography were normal.
The patient was admitted under joint cardiology and obstetric care and monitored with continuous telemetry. She was commenced on a therapeutic dose of low-molecular weight heparin (LMWH) and intravenous fluid. She received a single 200 Joule synchronized direct current (DC) shock under general anesthesia in operation theater, which reverted the rhythm back to normal. EFHR monitoring was normal pre- and post-DC cardioversion. We acknowledge the unwise use of therapeutic dose of LMWH before DC cardioversion (DCCV) because of a potential need for emergency cesarean delivery for maternal and/or fetal compromise.
The patient remained well and in sinus rhythm after cardioversion. She was discharged home the following day on Flecainide (anti-arrhythmic) and therapeutic dose of low molecular weight heparin (LMWH) and followed up in outpatient clinics frequently. She had a baby at term and received prophylactic LMWH for 10 days post-cesarean. She was discharged from cardiology clinic when she was 10 weeks postnatal, and Flecainide was discontinued.
We are reporting this case because of the rarity of the condition and successful use of DCCV for treating maternal AF. High-sensitive cardiac troponin T (hs-cTnT) level is a useful laboratory indicator to gauge the severity of AF in pregnancy. We emphasize to make the arrangements for EFHR monitoring and potential cesarean delivery and advocate cautious use of thromboprophylaxis while planning for electrical cardioversion (ECV) for maternal AF.
心房颤动（AF）在妊娠期间很少见。孕产妇房颤的管理具有挑战性，因为它对母婴健康都构成威胁。
我们报告了一例35周妊娠的妇女，她因突发心悸和轻度呼吸急促急诊就诊，无个人/家族心脏病史。
患者脉搏绝对不齐，平均心率为每分钟179次。产科检查正常。
高敏心肌肌钙蛋白T（hs-cTnT）升高。12导联心电图（ECG）确诊为房颤。产科超声、电子胎儿心率（EFHR）监测及产妇超声心动图均正常。
患者在心脏科和产科联合护理下入院，并进行持续遥测监测。开始给予治疗剂量的低分子量肝素（LMWH）和静脉输液。她在手术室接受全身麻醉下单次200焦耳同步直流电（DC）电击，心律恢复正常。DC心脏复律前后EFHR监测均正常。我们认识到在DC心脏复律（DCCV）前使用治疗剂量的LMWH是不明智的，因为可能需要紧急剖宫产以处理母婴并发症。
患者心脏复律后情况良好，维持窦性心律。次日出院，服用氟卡尼（抗心律失常药）和治疗剂量的低分子量肝素（LMWH），并在门诊频繁随访。她足月分娩，剖宫产术后接受预防性LMWH治疗10天。产后10周时她从心脏科门诊出院，停用氟卡尼。
我们报告此病例是因为该病罕见，且成功使用DCCV治疗孕产妇房颤。高敏心肌肌钙蛋白T（hs-cTnT）水平是评估妊娠期间房颤严重程度的有用实验室指标。我们强调要安排好EFHR监测和可能的剖宫产，并提倡在计划对孕产妇房颤进行电复律（ECV）时谨慎使用血栓预防措施。
