Tonko Johanna B, Douglas Hannah, Wright Matthew J
Department of Cardiology, St Thomas' Hospital, Westminster Bridge Rd, London SE1 7EH, UK.
Faculty of Life Sciences and Medicine, King's College London, Strand, London WC2R 2LS, UK.
Eur Heart J Case Rep. 2021 Sep 28;5(10):ytab367. doi: 10.1093/ehjcr/ytab367. eCollection 2021 Oct.
Automaticity is the dominant mechanism in maternal focal atrial tachycardia (FAT) during pregnancy and if incessant, can cause tachycardia-induced cardiomyopathy. Medication failure for FATs is common, however, for the subgroup due to increased automaticity ivabradine sensitivity has been described and may represent a valuable treatment option. Little data are available regarding the safety profile of ivabradine during pregnancy.
We report the case of a 38-year-old woman with background of peripartum cardiomyopathy and incessant atrial tachycardia with deteriorating ventricular function during her second pregnancy unresponsive to betablockade and demonstrating the immediate successful rate-controlling effect of ivabradine.
Early recognition of persistent maternal FAT is essential due to its frequent association with tachycardia-mediated cardiomyopathy. Our case report highlights the challenges of providing an equally safe and effective treatment of these notoriously difficult to treat arrhythmias during pregnancy. Ivabradine in combination with a betablocker can be effective for abnormal automaticity but its safety profile during pregnancy remains uncertain.
自律性是孕期母体局灶性房性心动过速（FAT）的主要机制，若为持续性，可导致心动过速性心肌病。FAT药物治疗失败很常见，然而，对于因自律性增加导致的亚组，已描述了伊伐布雷定敏感性，其可能是一种有价值的治疗选择。关于伊伐布雷定在孕期的安全性资料很少。
我们报告了一例38岁女性病例，其有围产期心肌病病史，在第二次怀孕时发生持续性房性心动过速，心室功能恶化，对β受体阻滞剂无反应，而伊伐布雷定显示出即刻成功的心率控制效果。
由于持续性母体FAT常与心动过速介导的心肌病相关，早期识别至关重要。我们的病例报告强调了在孕期为这些极难治疗的心律失常提供同样安全有效的治疗所面临的挑战。伊伐布雷定与β受体阻滞剂联合应用对异常自律性可能有效，但其在孕期的安全性仍不确定。
