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__NOTOC__
| colspan="3" align="center" bgcolor="#ABCDEF" | Conduction
{| class="infobox" style="float:right;"
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| [[File:Siren.gif|30px|link=Atrial fibrillation resident survival guide]]|| <br> || <br>
| [[Atrial fibrillation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
{| class="infobox" style="float:right;"
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| [[File:Critical_Pathways.gif|88px|link=Atrial fibrillation critical pathways]]|| <br> || <br>
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{| class="infobox" style="float:right;"
|-
|-
| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|75px]]
| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|75px]]
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|100px]]  
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|100px]]
|}
|}
{{Infobox_Disease |
  Name          =  |
  Image          =  |
  Caption        =  |
  DiseasesDB    = 1065 |
  ICD10          = {{ICD10|I|48||i|30}} |
  ICD9          = {{ICD9|427.31}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = 000184 |
  eMedicineSubj  = |
  eMedicineTopic = |
  eMedicine_mult = |
}}
{{Atrial fibrillation}}
{{Atrial fibrillation}}


{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[Varun Kumar, M.B.B.S.]]
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Varun Kumar, M.B.B.S.]] {{Anahita}}
 
'''''Synonyms and related keywords:''''' AF, Afib, fib


==Overview==
==Overview==
The presence of [[atrial fibrillation]] is rare in pregnancy and has an identifiable underlying etiology such as [[mitral stenosis]],<ref name="pmid2913749">Bryg RJ, Gordon PR, Kudesia VS, Bhatia RK (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2913749 Effect of pregnancy on pressure gradient in mitral stenosis.] ''Am J Cardiol'' 63 (5):384-6. PMID: [http://pubmed.gov/2913749 2913749]</ref> [[congenital heart disease]],<ref name="pmid7113941">Whittemore R, Hobbins JC, Engle MA (1982) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7113941 Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease.] ''Am J Cardiol'' 50 (3):641-51. PMID: [http://pubmed.gov/7113941 7113941]</ref> or [[hyperthyroidism]].<ref name="pmid110126">Forfar JC, Miller HC, Toft AD (1979) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=110126 Occult thyrotoxicosis: a correctable cause of "idiopathic" atrial fibrillation.] ''Am J Cardiol'' 44 (1):9-12. PMID: [http://pubmed.gov/110126 110126]</ref> [[Digoxin]], [[beta blocker]] or [[CCB|non-dihydropyridine CCB]] may be used to control the ventricular rate.<ref name="pmid7572599">Page RL (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7572599 Treatment of arrhythmias during pregnancy.] ''Am Heart J'' 130 (4):871-6. PMID: [http://pubmed.gov/7572599 7572599]</ref><ref name="pmid9737655">Chow T, Galvin J, McGovern B (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9737655 Antiarrhythmic drug therapy in pregnancy and lactation.] ''Am J Cardiol'' 82 (4A):58I-62I. PMID: [http://pubmed.gov/9737655 9737655]</ref><ref name="pmid1721219">O'Nunain S, Garratt CJ, Linker NJ, Gill J, Ward DE, Camm AJ (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1721219 A comparison of intravenous propafenone and flecainide in the treatment of tachycardias associated with the Wolff-Parkinson-White syndrome.] ''Pacing Clin Electrophysiol'' 14 (11 Pt 2):2028-34. PMID: [http://pubmed.gov/1721219 1721219]</ref>
Although physiologic changes during [[pregnancy]] cause some [[cardiovascular]] changes that may be [[Cardiac arrhythmia|arrhythmogenic]], [[prevelance]] of [[atrial fibrillation]] is very low among [[pregnancy|pregnant]] [[female|women]]. Presence of [[atrial fibrillation]] during [[pregnancy]] has an identifiable underlying [[etiology]] such as [[mitral stenosis]], [[congenital heart disease]], or [[hyperthyroidism]]. Therefore in a [[pregnancy|pregnant]] [[patient]] with [[atrial fibrillation]], conditions such as underlying [[Congenital disorder|congenital]] [[heart]] [[diseases]], [[valvular heart diseases]], [[electrolyte disturbance]], [[hyperthyroidism]] and [[Alcoholism|alcohol abuse]] should be evaluated. [[Atrial fibrillation]] during [[pregnancy]] has a wide range of presentation from a self limited and [[benign]] condition to sever and resistant [[arrhythmia]] with [[shock]] and [[fetus|fetal]] [[bradycardia]]. In the absence of [[heart failure]] [[digoxin]], [[beta blocker]] or [[CCB|non-dihydropyridine CCB]] may be used to control the [[ventricle|ventricular rate]]. [[Cardioversion]] is the [[treatment]] of choice in [[pregnancy|pregnanct]] [[patients]] with persistent [[atrial fibrillation]]. [[cardioversion|Synchronized electrical cardioversion]] is safe during all stages of [[pregnancy]].  
==Atrial Fibrillation and Pregnancy==
*Although physiologic changes during [[pregnancy]] cause some [[cardiovascular]] changes that may be [[Cardiac arrhythmia|arrhythmogenic]], [[prevelance]] of [[atrial fibrillation]] is very low among [[pregnancy|pregnant]] [[female|women]].<ref name="pmid28496671">{{cite journal| author=Cacciotti L, Passaseo I| title=Management of Atrial Fibrillation in Pregnancy. | journal=J Atr Fibrillation | year= 2010 | volume= 3 | issue= 3 | pages= 295 | pmid=28496671 | doi=10.4022/jafib.295 | pmc=4955905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28496671  }} </ref> 
*Based on one study done on [[pregnancy|pregnanct]] [[patients]] with history of [[Rheumatic fever|rheumatic heart disease]], 8% of them had [[atrial fibrillation]] at the onset of [[pregnancy]], nevertheless rate of [[atrial fibrillation]] development after becoming [[pregnancy|pregnanct]] was only 2.5%. <ref name="pmid28496671">{{cite journal| author=Cacciotti L, Passaseo I| title=Management of Atrial Fibrillation in Pregnancy. | journal=J Atr Fibrillation | year= 2010 | volume= 3 | issue= 3 | pages= 295 | pmid=28496671 | doi=10.4022/jafib.295 | pmc=4955905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28496671  }} </ref>
*Presence of [[atrial fibrillation]] during [[pregnancy]] has an identifiable underlying [[etiology]] such as [[mitral stenosis]], [[congenital heart disease]], or [[hyperthyroidism]].<ref name="pmid7113941">Whittemore R, Hobbins JC, Engle MA (1982) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7113941 Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease.] ''Am J Cardiol'' 50 (3):641-51. PMID: [http://pubmed.gov/7113941 7113941]</ref><ref name="pmid2913749">Bryg RJ, Gordon PR, Kudesia VS, Bhatia RK (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2913749 Effect of pregnancy on pressure gradient in mitral stenosis.] ''Am J Cardiol'' 63 (5):384-6. PMID: [http://pubmed.gov/2913749 2913749]</ref><ref name="pmid110126">Forfar JC, Miller HC, Toft AD (1979) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=110126 Occult thyrotoxicosis: a correctable cause of "idiopathic" atrial fibrillation.] ''Am J Cardiol'' 44 (1):9-12. PMID: [http://pubmed.gov/110126 110126]</ref><ref name="pmid21252800">{{cite journal| author=DiCarlo-Meacham LA, Dahlke LJ| title=Atrial fibrillation in pregnancy. | journal=Obstet Gynecol | year= 2011 | volume= 117 | issue= 2 Pt 2 | pages= 489-492 | pmid=21252800 | doi=10.1097/AOG.0b013e31820561ef | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21252800  }} </ref>
*Therefore in a [[pregnancy|pregnant]] [[patient]] with [[atrial fibrillation]], conditions such as underlying [[Congenital disorder|congenital]] [[heart]] [[diseases]], [[valvular heart diseases]], [[electrolyte disturbance]], [[hyperthyroidism]] and [[Alcoholism|alcohol abuse]] should be evaluated.<ref name="pmid28496671">{{cite journal| author=Cacciotti L, Passaseo I| title=Management of Atrial Fibrillation in Pregnancy. | journal=J Atr Fibrillation | year= 2010 | volume= 3 | issue= 3 | pages= 295 | pmid=28496671 | doi=10.4022/jafib.295 | pmc=4955905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28496671  }} </ref><ref name="pmid11693767">{{cite journal| author=Hameed A, Karaalp IS, Tummala PP, Wani OR, Canetti M, Akhter MW | display-authors=etal| title=The effect of valvular heart disease on maternal and fetal outcome of pregnancy. | journal=J Am Coll Cardiol | year= 2001 | volume= 37 | issue= 3 | pages= 893-9 | pmid=11693767 | doi=10.1016/s0735-1097(00)01198-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11693767  }} </ref><ref name="pmid12446072">{{cite journal| author=Autore C, Conte MR, Piccininno M, Bernabò P, Bonfiglio G, Bruzzi P | display-authors=etal| title=Risk associated with pregnancy in hypertrophic cardiomyopathy. | journal=J Am Coll Cardiol | year= 2002 | volume= 40 | issue= 10 | pages= 1864-9 | pmid=12446072 | doi=10.1016/s0735-1097(02)02495-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12446072  }} </ref>
*Usage of [[terbutaline]] as a [[tocolytic]] during [[pregnancy]] also could be related to [[atrial fibrillation]] development.<ref name="pmid28496671">{{cite journal| author=Cacciotti L, Passaseo I| title=Management of Atrial Fibrillation in Pregnancy. | journal=J Atr Fibrillation | year= 2010 | volume= 3 | issue= 3 | pages= 295 | pmid=28496671 | doi=10.4022/jafib.295 | pmc=4955905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28496671  }} </ref><ref name="pmid12423819">{{cite journal| author=Carson MP, Fisher AJ, Scorza WE| title=Atrial fibrillation in pregnancy associated with oral terbutaline. | journal=Obstet Gynecol | year= 2002 | volume= 100 | issue= 5 Pt 2 | pages= 1096-7 | pmid=12423819 | doi=10.1016/s0029-7844(02)02106-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12423819  }} </ref>
*[[Atrial fibrillation]] during [[pregnancy]] has a wide range of presentation from a self limited and [[benign]] condition to sever and resistant [[arrhythmia]] with [[shock]] and [[fetus|fetal]] [[bradycardia]].<ref name="pmid28496671">{{cite journal| author=Cacciotti L, Passaseo I| title=Management of Atrial Fibrillation in Pregnancy. | journal=J Atr Fibrillation | year= 2010 | volume= 3 | issue= 3 | pages= 295 | pmid=28496671 | doi=10.4022/jafib.295 | pmc=4955905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28496671  }} </ref>
*[[Fetus|Fetal]] growth surveillance is critical in [[pregnancy|pregnant]] [[patients]] with [[atrial fibrillation]].<ref name="pmid21252800">{{cite journal| author=DiCarlo-Meacham LA, Dahlke LJ| title=Atrial fibrillation in pregnancy. | journal=Obstet Gynecol | year= 2011 | volume= 117 | issue= 2 Pt 2 | pages= 489-492 | pmid=21252800 | doi=10.1097/AOG.0b013e31820561ef | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21252800  }} </ref><ref name="pmid28496671">{{cite journal| author=Cacciotti L, Passaseo I| title=Management of Atrial Fibrillation in Pregnancy. | journal=J Atr Fibrillation | year= 2010 | volume= 3 | issue= 3 | pages= 295 | pmid=28496671 | doi=10.4022/jafib.295 | pmc=4955905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28496671  }} </ref>
*In the absence of [[heart failure]] [[digoxin]], [[beta blocker]] or [[CCB|non-dihydropyridine CCB]] may be used to control the [[ventricle|ventricular rate]]. Although [[Intravenous therapy|intravenous administration]] of [[digoxin]] and [[CCB|non-dihydropyridine CCB]] is not recommended in [[patients]] with [[atrial fibrillation]] and a [[pre-excitation syndrome]], since they might accelerate the [[ventricle|ventricular response]].<ref name="pmid7572599">Page RL (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7572599 Treatment of arrhythmias during pregnancy.] ''Am Heart J'' 130 (4):871-6. PMID: [http://pubmed.gov/7572599 7572599]</ref><ref name="pmid9737655">Chow T, Galvin J, McGovern B (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9737655 Antiarrhythmic drug therapy in pregnancy and lactation.] ''Am J Cardiol'' 82 (4A):58I-62I. PMID: [http://pubmed.gov/9737655 9737655]</ref><ref name="pmid1721219">O'Nunain S, Garratt CJ, Linker NJ, Gill J, Ward DE, Camm AJ (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1721219 A comparison of intravenous propafenone and flecainide in the treatment of tachycardias associated with the Wolff-Parkinson-White syndrome.] ''Pacing Clin Electrophysiol'' 14 (11 Pt 2):2028-34. PMID: [http://pubmed.gov/1721219 1721219]</ref><ref name="pmid28496671">{{cite journal| author=Cacciotti L, Passaseo I| title=Management of Atrial Fibrillation in Pregnancy. | journal=J Atr Fibrillation | year= 2010 | volume= 3 | issue= 3 | pages= 295 | pmid=28496671 | doi=10.4022/jafib.295 | pmc=4955905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28496671  }} </ref><ref name="pmid16904574">{{cite journal| author=European Heart Rhythm Association. Heart Rhythm Society. Fuster V, Rydén LE, Cannom DS, Crijns HJ | display-authors=etal| title=ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). | journal=J Am Coll Cardiol | year= 2006 | volume= 48 | issue= 4 | pages= 854-906 | pmid=16904574 | doi=10.1016/j.jacc.2006.07.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16904574  }} </ref>
*Among [[beta blockers]], cardioselective agents such as [[metoprolol]] and [[atenolol]] are preferred. <ref name="pmid28496671">{{cite journal| author=Cacciotti L, Passaseo I| title=Management of Atrial Fibrillation in Pregnancy. | journal=J Atr Fibrillation | year= 2010 | volume= 3 | issue= 3 | pages= 295 | pmid=28496671 | doi=10.4022/jafib.295 | pmc=4955905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28496671  }} </ref>
*[[Quinidine]] has been shown to be safe in [[pregnancy]] and remains the [[drug]] of choice for [[Atrial fibrillation cardioversion|pharmacological cardioversion]] of [[atrial fbrillation]] in [[pregnancy]].<ref name="pmid6144698">Vaughan Williams EM (1984) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6144698 A classification of antiarrhythmic actions reassessed after a decade of new drugs.] ''J Clin Pharmacol'' 24 (4):129-47. PMID: [http://pubmed.gov/6144698 6144698]</ref>
*[[Cardioversion]] is the [[treatment]] of choice in [[pregnancy|pregnanct]] [[patients]] with persistent [[atrial fibrillation]]. [[cardioversion|Synchronized electrical cardioversion]] is safe during all stages of [[pregnancy]].<ref name="pmid21252800">{{cite journal| author=DiCarlo-Meacham LA, Dahlke LJ| title=Atrial fibrillation in pregnancy. | journal=Obstet Gynecol | year= 2011 | volume= 117 | issue= 2 Pt 2 | pages= 489-492 | pmid=21252800 | doi=10.1097/AOG.0b013e31820561ef | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21252800  }} </ref><ref name="pmid28496671">{{cite journal| author=Cacciotti L, Passaseo I| title=Management of Atrial Fibrillation in Pregnancy. | journal=J Atr Fibrillation | year= 2010 | volume= 3 | issue= 3 | pages= 295 | pmid=28496671 | doi=10.4022/jafib.295 | pmc=4955905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28496671  }} </ref>
*In cases of [[shock|hemodynamic instability]], [[Atrial fibrillation cardioversion|direct-current cardioversion]] may be performed without [[Fetus|fetal]] damage.<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref>
*In severe and resistant cases that [[atrial fibrillation]] has been led to [[shock]] and consequent [[fetus|fetal]] [[bradycardia]], urgent [[caesarean section]] under supervision of [[Obstetrics and gynaecology|obstetric specialist]] and [[Cardiology|cardiologist]] might be warranted.<ref name="pmid28496671">{{cite journal| author=Cacciotti L, Passaseo I| title=Management of Atrial Fibrillation in Pregnancy. | journal=J Atr Fibrillation | year= 2010 | volume= 3 | issue= 3 | pages= 295 | pmid=28496671 | doi=10.4022/jafib.295 | pmc=4955905 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28496671  }} </ref>


==ACCF/AHA/HRS 2011 Guidelines- Pregnancy (DO NOT EDIT) <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref><ref name="pmid21382897">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=21382897 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines.] ''Circulation'' 123 (10):e269-367. [http://dx.doi.org/10.1161/CIR.0b013e318214876d DOI:10.1161/CIR.0b013e318214876d] PMID: [http://pubmed.gov/21382897 21382897]</ref>==
==2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial                    Fibrillation (DO NOT EDIT)<ref name="pmid21392637">{{cite journal| author=Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al.| title=2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2011 | volume= 57 | issue= 11 | pages= e101-98 | pmid=21392637 | doi=10.1016/j.jacc.2010.09.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21392637  }} </ref>==
{{cquote|
===Pregnancy (DO NOT EDIT) <ref name="pmid21392637">{{cite journal| author=Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al.| title=2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2011 | volume= 57 | issue= 11 | pages= e101-98 | pmid=21392637 | doi=10.1016/j.jacc.2010.09.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21392637  }} </ref>===
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===
'''1.''' [[Digoxin]], a [[beta blocker]], or a non [[dihydropyridine]] [[calcium channel antagonist]] is recommended to control the rate of ventricular response in [[pregnant]] patients with [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''


'''2.''' [[Direct-current cardioversion]] is recommended in pregnant patients who become hemodynamically unstable due to [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' [[Digoxin]], [[beta blockers]], or non [[dihydropyridine]] [[calcium channel antagonists]] are recommended to control the rate of [[ventricle|ventricular]] response in [[pregnant]] [[patients]] with [[atrial fibrillation]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Direct-current cardioversion]] is recommended in [[pregnancy|pregnant]] [[patients]] who become [[shock|hemodynamically unstable]] due to [[atrial fibrillation]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Protection against [[thromboembolism]] is recommended throughout [[pregnancy]] for all [[patients]] with [[atrial fibrillation]] (except those with lone [[atrial fibrillation]] and/or low thromboembolic risk). [[Therapy]] ([[anticoagulant]] or [[aspirin]]) should be chosen according to the stage of [[pregnancy]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}


'''3.''' Protection against [[thromboembolism]] is recommended throughout [[pregnancy]] for all patients with [[AF]] (except those with lone [[AF]] and/or low thromboembolic risk). Therapy ([[anticoagulant]] or [[aspirin]]) should be chosen according to the stage of [[pregnancy]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Administration of [[heparin]] may be considered during the [[pregnancy|first trimester]] and last month of [[pregnancy]] for [[patients]] with [[atrial fibrillation]] and [[risk factors]] for [[thromboembolism]]. [[Unfractionated heparin]] may be administered either by [[Injection (medicine)|continuous intravenous infusion]] in a [[dose]] sufficient to prolong the activated [[partial thromboplastin time]] to 1.5 to 2 times the control value or by [[Injection (medicine)|intermittent subcutaneous injection]] in a [[dose]] of 10 000 to 20 000 units every 12 h, adjusted to prolong the mid-interval (6 h after injection) activated [[partial thromboplastin time]] to 1.5 times control. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' Despite the limited data available, [[Subcutaneous tissue|subcutaneous administration]] of [[low-molecular-weight heparin]] may be considered during the [[pregnancy|first trimester]] and last month of [[pregnancy]] for [[patients]] with [[atrial fibrillation]] ([[AF]]) and [[risk factors]] for [[thromboembolism]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Administration of an [[mouth|oral]] [[anticoagulant]] may be considered during the [[pregnancy|second trimester]] for [[pregnant]] [[patients]] with [[atrial fibrillation]] ([[AF]]) at high thromboembolic risk. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' Administration of [[quinidine]] or [[procainamide]] may be considered to achieve [[pharmacology|pharmacological]] [[cardioversion]] in [[Hemodynamics|hemodynamically]] stable [[patients]] who develop [[atrial fibrillation]] ([[AF]]) during [[pregnancy]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}


===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===
==Sources==
'''1.''' Administration of [[heparin]] may be considered during the first trimester and last month of [[pregnancy]] for patients with [[AF]] and risk factors for [[thromboembolism]]. [[Unfractionated heparin]] may be administered either by continuous intravenous infusion in a dose sufficient to prolong the [[activated partial thromboplastin time]] to 1.5 to 2 times the control value or by intermittent subcutaneous injection in a dose of 10 000 to 20 000 units every 12 h, adjusted to prolong the mid-interval (6 h after injection) [[activated partial thromboplastin time]] to 1.5 times control. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
 
'''2.''' Despite the limited data available, subcutaneous administration of [[low molecular weight heparin]] may be considered during the first trimester and last month of [[pregnancy]] for patients with [[AF]] and risk factors for [[thromboembolism]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''3.''' Administration of an oral [[anticoagulant]] may be considered during the second trimester for [[pregnant]] patients with [[AF]] at high thromboembolic risk. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''
 
'''4.''' Administration of [[quinidine]] or [[procainamide]] may be considered to achieve pharmacological [[cardioversion]] in hemodynamically stable patients who develop [[AF]] during pregnancy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''}}
 
==Vote on and Suggest Revisions to the Current Guidelines==
* [[The Living Guidelines: Diagnosis and Management of Atrial Fibrillation | The AF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
 
==Guideline Resources==
*[http://content.onlinejacc.org/cgi/reprint/48/4/e149.pdf ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation] <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref>
*[http://content.onlinejacc.org/cgi/reprint/48/4/e149.pdf ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation] <ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.] ''Circulation'' 114 (7):e257-354. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref>


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==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[CME Category::Cardiology]]


[[Category:Electrophysiology]]
[[Category:Electrophysiology]]
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Latest revision as of 20:36, 18 September 2021
Resident
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Atrial fibrillation pregnancy On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. Anahita Deylamsalehi, M.D.[2]

Overview

Although physiologic changes during pregnancy cause some cardiovascular changes that may be arrhythmogenic, prevelance of atrial fibrillation is very low among pregnant women. Presence of atrial fibrillation during pregnancy has an identifiable underlying etiology such as mitral stenosis, congenital heart disease, or hyperthyroidism. Therefore in a pregnant patient with atrial fibrillation, conditions such as underlying congenital heart diseases, valvular heart diseases, electrolyte disturbance, hyperthyroidism and alcohol abuse should be evaluated. Atrial fibrillation during pregnancy has a wide range of presentation from a self limited and benign condition to sever and resistant arrhythmia with shock and fetal bradycardia. In the absence of heart failure digoxin, beta blocker or non-dihydropyridine CCB may be used to control the ventricular rate. Cardioversion is the treatment of choice in pregnanct patients with persistent atrial fibrillation. Synchronized electrical cardioversion is safe during all stages of pregnancy.

Atrial Fibrillation and Pregnancy

2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[15]

Pregnancy (DO NOT EDIT) [15]

Class I
"1. Digoxin, beta blockers, or non dihydropyridine calcium channel antagonists are recommended to control the rate of ventricular response in pregnant patients with atrial fibrillation. (Level of Evidence: C)"
"2. Direct-current cardioversion is recommended in pregnant patients who become hemodynamically unstable due to atrial fibrillation. (Level of Evidence: C)"
"3. Protection against thromboembolism is recommended throughout pregnancy for all patients with atrial fibrillation (except those with lone atrial fibrillation and/or low thromboembolic risk). Therapy (anticoagulant or aspirin) should be chosen according to the stage of pregnancy. (Level of Evidence: C)"
Class IIb
"1. Administration of heparin may be considered during the first trimester and last month of pregnancy for patients with atrial fibrillation and risk factors for thromboembolism. Unfractionated heparin may be administered either by continuous intravenous infusion in a dose sufficient to prolong the activated partial thromboplastin time to 1.5 to 2 times the control value or by intermittent subcutaneous injection in a dose of 10 000 to 20 000 units every 12 h, adjusted to prolong the mid-interval (6 h after injection) activated partial thromboplastin time to 1.5 times control. (Level of Evidence: B)"
"2. Despite the limited data available, subcutaneous administration of low-molecular-weight heparin may be considered during the first trimester and last month of pregnancy for patients with atrial fibrillation (AF) and risk factors for thromboembolism. (Level of Evidence: B)"
"3. Administration of an oral anticoagulant may be considered during the second trimester for pregnant patients with atrial fibrillation (AF) at high thromboembolic risk. (Level of Evidence: C)"
"4. Administration of quinidine or procainamide may be considered to achieve pharmacological cardioversion in hemodynamically stable patients who develop atrial fibrillation (AF) during pregnancy. (Level of Evidence: C)"

Sources

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Cacciotti L, Passaseo I (2010). "Management of Atrial Fibrillation in Pregnancy". J Atr Fibrillation. 3 (3): 295. doi:10.4022/jafib.295. PMC 4955905. PMID 28496671.
  2. ↑ Whittemore R, Hobbins JC, Engle MA (1982) Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. Am J Cardiol 50 (3):641-51. PMID: 7113941
  3. ↑ Bryg RJ, Gordon PR, Kudesia VS, Bhatia RK (1989) Effect of pregnancy on pressure gradient in mitral stenosis. Am J Cardiol 63 (5):384-6. PMID: 2913749
  4. ↑ Forfar JC, Miller HC, Toft AD (1979) Occult thyrotoxicosis: a correctable cause of "idiopathic" atrial fibrillation. Am J Cardiol 44 (1):9-12. PMID: 110126
  5. ↑ 5.0 5.1 5.2 DiCarlo-Meacham LA, Dahlke LJ (2011). "Atrial fibrillation in pregnancy". Obstet Gynecol. 117 (2 Pt 2): 489–492. doi:10.1097/AOG.0b013e31820561ef. PMID 21252800.
  6. ↑ Hameed A, Karaalp IS, Tummala PP, Wani OR, Canetti M, Akhter MW; et al. (2001). "The effect of valvular heart disease on maternal and fetal outcome of pregnancy". J Am Coll Cardiol. 37 (3): 893–9. doi:10.1016/s0735-1097(00)01198-0. PMID 11693767.
  7. ↑ Autore C, Conte MR, Piccininno M, Bernabò P, Bonfiglio G, Bruzzi P; et al. (2002). "Risk associated with pregnancy in hypertrophic cardiomyopathy". J Am Coll Cardiol. 40 (10): 1864–9. doi:10.1016/s0735-1097(02)02495-6. PMID 12446072.
  8. ↑ Carson MP, Fisher AJ, Scorza WE (2002). "Atrial fibrillation in pregnancy associated with oral terbutaline". Obstet Gynecol. 100 (5 Pt 2): 1096–7. doi:10.1016/s0029-7844(02)02106-3. PMID 12423819.
  9. ↑ Page RL (1995) Treatment of arrhythmias during pregnancy. Am Heart J 130 (4):871-6. PMID: 7572599
  10. ↑ Chow T, Galvin J, McGovern B (1998) Antiarrhythmic drug therapy in pregnancy and lactation. Am J Cardiol 82 (4A):58I-62I. PMID: 9737655
  11. ↑ O'Nunain S, Garratt CJ, Linker NJ, Gill J, Ward DE, Camm AJ (1991) A comparison of intravenous propafenone and flecainide in the treatment of tachycardias associated with the Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol 14 (11 Pt 2):2028-34. PMID: 1721219
  12. ↑ European Heart Rhythm Association. Heart Rhythm Society. Fuster V, Rydén LE, Cannom DS, Crijns HJ; et al. (2006). "ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation)". J Am Coll Cardiol. 48 (4): 854–906. doi:10.1016/j.jacc.2006.07.009. PMID 16904574.
  13. ↑ Vaughan Williams EM (1984) A classification of antiarrhythmic actions reassessed after a decade of new drugs. J Clin Pharmacol 24 (4):129-47. PMID: 6144698
  14. ↑ 14.0 14.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
  15. ↑ 15.0 15.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA; et al. (2011). "2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". J Am Coll Cardiol. 57 (11): e101–98. doi:10.1016/j.jacc.2010.09.013. PMID 21392637.
  16. ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
  17. ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199

CME Category::Cardiology

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