ANESTHETIC MANAGEMENT OF PREGNANT WOMEN WITH CARDIAC ARRHYTHMIAS: CURRENT EVIDENCE
ANESTHETIC MANAGEMENT OF PREGNANT WOMEN WITH CARDIAC ARRHYTHMIAS: CURRENT EVIDENCE

Summary/Abstract: Background: Heart disease remains a leading cause of maternal mortality worldwide, exacerbated by pregnancy-related physiological changes affecting cardiovascular function, respiratory dynamics, hematological parameters, and pharmacokinetics – all of which influence maternal and fetal outcomes, as well as anesthetic management. Cardiac arrhythmias may be intensified by hemodynamic and hormonal changes during pregnancy. Furthermore, conditions such as peripartum cardiomyopathy, Takotsubo syndrome, myocardial infarction, and post–heart transplantation complications increase the risk of arrhythmias and adverse maternal and fetal outcomes, requiring specialized management to mitigate complications such as heart failure, thromboembolism, and cardiac arrest.Aim of the study: To review current evidence on anesthetic management in pregnant women with cardiac arrhythmias and other arrhythmia-inducing heart diseases.Material and methods: The review was conducted using articles and guidelines from PubMed, the National Institutes of Health (NIH), the Medycyna Praktyczna website, SpringerMedizin, Semantic Scholar, and book sources. Based on 420 articles, 4 books, and WHO/NIH sources, 43 key references (20 published after 2022) were analyzed.Results: Pregnancy induces significant cardiovascular and respiratory changes. Respiratory adaptations and hematologic alterations affect anesthesia and drug pharmacokinetics. Arrhythmias such as atrial fibrillation are treated with beta-blockers, verapamil, or cardioversion. The risk of arrhythmia is 47.91 times higher in patients with cardiomyopathy than in healthy individuals. Peripartum cardiomyopathy carries a high risk of arrhythmias. Takotsubo syndrome, often occurring in the peripartum period, is associated with catecholamine surges and is managed with beta-blockers and diuretics. Myocardial infarction is also associated with an increased risk of developing arrhythmias during pregnancy. Heart transplant recipients frequently experience concomitant cardiac arrhythmias and face significantly increased risks of maternal morbidity and preterm birth, necessitating specialized, multidisciplinary care.Conclusions: Pregnancy-induced physiological adaptations increase the risk of arrhythmias and require specialized management to mitigate maternal and fetal complications. Optimal outcomes depend on multidisciplinary care, individualized anesthesia, and rigorous monitoring.

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