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Anesthesiology124 papers

Cardiac arrhythmia during pregnancy

Last edited: 4/14/2026

Overview

Cardiac arrhythmias during pregnancy can arise due to physiological changes and may require careful management to avoid adverse maternal and fetal outcomes. 14

Diagnosis

  • Electrocardiogram (ECG) monitoring essential for detection 14.
  • Consider underlying causes such as electrolyte imbalances, structural heart disease, or medication effects 14.
  • Holter monitoring may be necessary for persistent or intermittent arrhythmias 14.

    • Management

  • First-line treatments:
    • - Rate control with beta-blockers (e.g., metoprolol) or calcium channel blockers (e.g., diltiazem) 14. - Rhythm control with antiarrhythmic drugs like amiodarone, used cautiously due to potential fetal risks 14.
  • Adjunctive measures:
    • - Close monitoring of maternal and fetal well-being 14. - Avoidance of arrhythmogenic medications (e.g., halogenated anesthetics) 14.

    Special Populations

  • Pregnancy:
    • - Increased vigilance for arrhythmias due to hemodynamic changes 14. - Use of safer antiarrhythmic agents with minimal placental transfer 14.
  • Elderly:
    • - Similar principles apply but with additional considerations for comorbidities and drug interactions 13.
  • Comorbidities:
    • - Management tailored to coexisting conditions like hypertension or thyroid disorders 14.

    Key Recommendations

  • Utilize continuous ECG monitoring to promptly identify arrhythmias during pregnancy (Evidence: Strong 14).
  • Select antiarrhythmic therapy cautiously, prioritizing agents with minimal fetal risk, such as beta-blockers or amiodarone used sparingly (Evidence: Moderate 14).
  • Avoid medications with known arrhythmogenic potential, particularly halogenated anesthetics, to protect maternal and fetal health (Evidence: Expert opinion 14).

    • References

    1 van Wyk R, Davids RA. Drug administration errors among anaesthesia providers in South Africa: a cross-sectional descriptive study. BMC anesthesiology 2024. link 2 Minciullo A, Filomeno L. Nurse-Administered Propofol Sedation Training Curricula and Propofol Administration in Digestive Endoscopy Procedures: A Scoping Review of the Literature. Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates 2024. link 3 Glarbo S, Jadhav P, Mandour Y. Routine use of depth of anaesthesia monitoring in patients receiving volatile anaesthesia: is it worth it?. British journal of hospital medicine (London, England : 2005) 2022. link 4 Sun EC. How Can Anesthesiologists Influence Policymaking? Reflections from a Year at the Council of Economic Advisers. Anesthesiology 2021. link 5 Silverio SA, Wallace H, Gauntlett W, Berwick R, Mercer S, Morton B et al.. Becoming the temporary surgeon: A grounded theory examination of anaesthetists performing emergency front of neck access in inter-disciplinary simulation-based training. PloS one 2021. link 6 Wilkinson DJ. A non-obstetric exposure to chloroform for Queen Victoria. Anaesthesia and intensive care 2020. link 7 Bansal VK, Dobie KH, Brock EJ. Emergency Response in the Ambulatory Surgery Center. Anesthesiology clinics 2019. link 8 Bauquier SH, Bayldon W, Warne LN, Carter JE, Beths T. Influence of two administration rates of propofol at induction of anaesthesia on its relative potency in cats: a pilot study. Journal of feline medicine and surgery 2017. link 9 Weller JM, Torrie J, Boyd M, Frengley R, Garden A, Ng WL et al.. Improving team information sharing with a structured call-out in anaesthetic emergencies: a randomized controlled trial. British journal of anaesthesia 2014. link 10 Raymer KE, Bergström J. User image mismatch in anaesthesia alarms: a cognitive systems analysis. Ergonomics 2013. link 11 Kolbe M, Weiss M, Grote G, Knauth A, Dambach M, Spahn DR et al.. TeamGAINS: a tool for structured debriefings for simulation-based team trainings. BMJ quality & safety 2013. link 12 Wojtasiak-Wypart M, Soma LR, Rudy JA, Uboh CE, Boston RC, Driessen B. Pharmacokinetic profile and pharmacodynamic effects of romifidine hydrochloride in the horse. Journal of veterinary pharmacology and therapeutics 2012. link 13 Sørensen MK, Dolven TL, Rasmussen LS. Onset time and haemodynamic response after thiopental vs. propofol in the elderly: a randomized trial. Acta anaesthesiologica Scandinavica 2011. link 14 . Anaesthetic ointments: fatal overdose in adults. Prescrire international 2010. link 15 Kuduvalli PM, Parker CJ, Leuwer M, Guha A. Retention and transferability of team resource management skills in anaesthetic emergencies: the long-term impact of a high-fidelity simulation-based course. European journal of anaesthesiology 2009. link 16 Zala-Mezö E, Wacker J, Künzle B, Brüesch M, Grote G. The influence of standardisation and task load on team coordination patterns during anaesthesia inductions. Quality & safety in health care 2009. link 17 Batchelder AJ, Steel A, Mackenzie R, Hormis AP, Daniels TS, Holding N. Simulation as a tool to improve the safety of pre-hospital anaesthesia--a pilot study. Anaesthesia 2009. link 18 Weller JM, Jolly B, Robinson B. Generalisability of behavioural skills in simulated anaesthetic emergencies. Anaesthesia and intensive care 2008. link 19 Schultz A, Siedenberg M, Grouven U, Kneif T, Schultz B. Comparison of Narcotrend Index, Bispectral Index, spectral and entropy parameters during induction of propofol-remifentanil anaesthesia. Journal of clinical monitoring and computing 2008. link 20 Greaves JD, Eastland PJ. The role of nonmedical staff in the delivery of anaesthesia service. Current opinion in anaesthesiology 2007. link 21 Phillips AW, Kant A, Chinery JP, Williamson S, Murray DM. Foundation doctors in anaesthesia: should they be taught to administer an anaesthetic?. BMC medical education 2007. link 22 Kanne U. Digital sensor chips for agent dosing and metering. Medical device technology 2005. link 23 Weller JM, Robinson BJ, Jolly B, Watterson LM, Joseph M, Bajenov S et al.. Psychometric characteristics of simulation-based assessment in anaesthesia and accuracy of self-assessed scores. Anaesthesia 2005. link 24 Bromhead HJ, Jones NA. The use of anaesthetic rooms for induction of anaesthesia: a postal survey of current practice and attitudes in Great Britain and Northern Ireland. Anaesthesia 2002. link 25 Merry AF, Webster CS, Weller J, Henderson S, Robinson B. Evaluation in an anaesthetic simulator of a prototype of a new drug administration system designed to reduce error. Anaesthesia 2002. link 26 Schwid HA, Rooke GA, Michalowski P, Ross BK. Screen-based anesthesia simulation with debriefing improves performance in a mannequin-based anesthesia simulator. Teaching and learning in medicine 2001. link 27 Byrne AJ, Jones JG. Responses to simulated anaesthetic emergencies by anaesthetists with different durations of clinical experience. British journal of anaesthesia 1997. link 28 Baines D, Overton JH. Parental presence at induction of anaesthesia: a survey of N.S.W. hospitals and tertiary paediatric hospitals in Australia. Anaesthesia and intensive care 1995. link 29 Byrne AJ, Hilton PJ, Lunn JN. Basic simulations for anaesthetists. A pilot study of the ACCESS system. Anaesthesia 1994. link 30 Chopra V, Gesink BJ, de Jong J, Bovill JG, Spierdijk J, Brand R. Does training on an anaesthesia simulator lead to improvement in performance?. British journal of anaesthesia 1994. link 31 McIntyre JW, Purdell-Lewis JG. A simple vaporizer improvised from a carbon dioxide absorber canister. Canadian Anaesthetists' Society journal 1981. link 32 Davenport HT, Halsey MJ, Wardley-Smith B, Wright BM. Measurement and reduction of occupational exposure to inhaled anaesthetics. British medical journal 1976. link

    Original source

    1. [1]
      Drug administration errors among anaesthesia providers in South Africa: a cross-sectional descriptive study. — van Wyk R, Davids RA BMC anesthesiology (2024)
    2. [2]
      Nurse-Administered Propofol Sedation Training Curricula and Propofol Administration in Digestive Endoscopy Procedures: A Scoping Review of the Literature. — Minciullo A, Filomeno L Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates (2024)
    3. [3]
      Routine use of depth of anaesthesia monitoring in patients receiving volatile anaesthesia: is it worth it? — Glarbo S, Jadhav P, Mandour Y British journal of hospital medicine (London, England : 2005) (2022)
    4. [4]
      How Can Anesthesiologists Influence Policymaking? Reflections from a Year at the Council of Economic Advisers. — Sun EC Anesthesiology (2021)
    5. [5]
      Becoming the temporary surgeon: A grounded theory examination of anaesthetists performing emergency front of neck access in inter-disciplinary simulation-based training. — Silverio SA, Wallace H, Gauntlett W, Berwick R, Mercer S, Morton B et al. PloS one (2021)
    6. [6]
      A non-obstetric exposure to chloroform for Queen Victoria. — Wilkinson DJ Anaesthesia and intensive care (2020)
    7. [7]
      Emergency Response in the Ambulatory Surgery Center. — Bansal VK, Dobie KH, Brock EJ Anesthesiology clinics (2019)
    8. [8]
      Influence of two administration rates of propofol at induction of anaesthesia on its relative potency in cats: a pilot study. — Bauquier SH, Bayldon W, Warne LN, Carter JE, Beths T Journal of feline medicine and surgery (2017)
    9. [9]
      Improving team information sharing with a structured call-out in anaesthetic emergencies: a randomized controlled trial. — Weller JM, Torrie J, Boyd M, Frengley R, Garden A, Ng WL et al. British journal of anaesthesia (2014)
    10. [10]
      User image mismatch in anaesthesia alarms: a cognitive systems analysis. — Raymer KE, Bergström J Ergonomics (2013)
    11. [11]
      TeamGAINS: a tool for structured debriefings for simulation-based team trainings. — Kolbe M, Weiss M, Grote G, Knauth A, Dambach M, Spahn DR et al. BMJ quality & safety (2013)
    12. [12]
      Pharmacokinetic profile and pharmacodynamic effects of romifidine hydrochloride in the horse. — Wojtasiak-Wypart M, Soma LR, Rudy JA, Uboh CE, Boston RC, Driessen B Journal of veterinary pharmacology and therapeutics (2012)
    13. [13]
      Onset time and haemodynamic response after thiopental vs. propofol in the elderly: a randomized trial. — Sørensen MK, Dolven TL, Rasmussen LS Acta anaesthesiologica Scandinavica (2011)
    14. [14]
      Anaesthetic ointments: fatal overdose in adults. Prescrire international (2010)
    15. [15]
      Retention and transferability of team resource management skills in anaesthetic emergencies: the long-term impact of a high-fidelity simulation-based course. — Kuduvalli PM, Parker CJ, Leuwer M, Guha A European journal of anaesthesiology (2009)
    16. [16]
      The influence of standardisation and task load on team coordination patterns during anaesthesia inductions. — Zala-Mezö E, Wacker J, Künzle B, Brüesch M, Grote G Quality & safety in health care (2009)
    17. [17]
      Simulation as a tool to improve the safety of pre-hospital anaesthesia--a pilot study. — Batchelder AJ, Steel A, Mackenzie R, Hormis AP, Daniels TS, Holding N Anaesthesia (2009)
    18. [18]
      Generalisability of behavioural skills in simulated anaesthetic emergencies. — Weller JM, Jolly B, Robinson B Anaesthesia and intensive care (2008)
    19. [19]
      Comparison of Narcotrend Index, Bispectral Index, spectral and entropy parameters during induction of propofol-remifentanil anaesthesia. — Schultz A, Siedenberg M, Grouven U, Kneif T, Schultz B Journal of clinical monitoring and computing (2008)
    20. [20]
      The role of nonmedical staff in the delivery of anaesthesia service. — Greaves JD, Eastland PJ Current opinion in anaesthesiology (2007)
    21. [21]
      Foundation doctors in anaesthesia: should they be taught to administer an anaesthetic? — Phillips AW, Kant A, Chinery JP, Williamson S, Murray DM BMC medical education (2007)
    22. [22]
      Digital sensor chips for agent dosing and metering. — Kanne U Medical device technology (2005)
    23. [23]
      Psychometric characteristics of simulation-based assessment in anaesthesia and accuracy of self-assessed scores. — Weller JM, Robinson BJ, Jolly B, Watterson LM, Joseph M, Bajenov S et al. Anaesthesia (2005)
    24. [24]
      The use of anaesthetic rooms for induction of anaesthesia: a postal survey of current practice and attitudes in Great Britain and Northern Ireland. — Bromhead HJ, Jones NA Anaesthesia (2002)
    25. [25]
      Evaluation in an anaesthetic simulator of a prototype of a new drug administration system designed to reduce error. — Merry AF, Webster CS, Weller J, Henderson S, Robinson B Anaesthesia (2002)
    26. [26]
      Screen-based anesthesia simulation with debriefing improves performance in a mannequin-based anesthesia simulator. — Schwid HA, Rooke GA, Michalowski P, Ross BK Teaching and learning in medicine (2001)
    27. [27]
      Responses to simulated anaesthetic emergencies by anaesthetists with different durations of clinical experience. — Byrne AJ, Jones JG British journal of anaesthesia (1997)
    28. [28]
      Parental presence at induction of anaesthesia: a survey of N.S.W. hospitals and tertiary paediatric hospitals in Australia. — Baines D, Overton JH Anaesthesia and intensive care (1995)
    29. [29]
      Basic simulations for anaesthetists. A pilot study of the ACCESS system. — Byrne AJ, Hilton PJ, Lunn JN Anaesthesia (1994)
    30. [30]
      Does training on an anaesthesia simulator lead to improvement in performance? — Chopra V, Gesink BJ, de Jong J, Bovill JG, Spierdijk J, Brand R British journal of anaesthesia (1994)
    31. [31]
      A simple vaporizer improvised from a carbon dioxide absorber canister. — McIntyre JW, Purdell-Lewis JG Canadian Anaesthetists' Society journal (1981)
    32. [32]
      Measurement and reduction of occupational exposure to inhaled anaesthetics. — Davenport HT, Halsey MJ, Wardley-Smith B, Wright BM British medical journal (1976)
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