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Topic 13601 Version 28.0 https://www.uptodate.com/contents/ventricular-arrhythmias-during-pregnancy/print 21/25 7/6/23, 3:34 PM Ventricular arrhythmias during pregnancy - UpToDate GRAPHICS Prevalence of arrhythmias during pregnancy in women with congenital heart disease AOS: aortic stenosis; ASD: atrial septal defect; AVSD: atrioventricular septal defect; CC-TGA: congenital corrected transposition of the great arteries; CHD: congenital heart disease; PAVSD: pulmonary atresia with ventricular septal defect; TGA: transposition of the great arteries; TOF: tetralogy of Fallot. Data from: Drenthen W, Pieper PG, Roos-Hesselink JW, et al. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol 2007; 49:2303. Graphic 61986 Version 4.0 https://www.uptodate.com/contents/ventricular-arrhythmias-during-pregnancy/print 22/25 7/6/23, 3:34 PM Ventricular arrhythmias during pregnancy - UpToDate Antiarrhythmic drugs in pregnancy Drug Pregnancy Breastfeeding Amiodarone Has been associated with serious adverse effects. Congenital goiter/hypothyroidism and hyperthyroidism can occur after in utero exposure. Other potential risks Not recommended because of potential risk of hypothyroidism in neonate. include prolonged QT interval in neonates. Beta blockers No evidence of increased risk of teratogenesis, but some (particularly atenolol) may impair fetal growth when used for a prolonged duration in the The AAP considers these agents compatible with breastfeeding, but newborns should be observed for signs of beta blockade. second and third trimesters. Use only Atenolol is a weak base that will accumulate in milk. Accumulation is in the third trimester is associated with reduced placental weight. enhanced by its water-soluble, low protein binding, little or no hepatic Newborns of patients taking these drugs near delivery are at risk of bradycardia, hypoglycemia, and other metabolism, and renal excretion properties. Because it has been symptoms of beta blockade. associated with beta-blocking effects and cyanosis in nursing infants, it is best avoided during breastfeeding. Among this class of drugs, atenolol appears to have the most unfavorable effect on birthweight. Sotalol Sotalol, which has both beta blocker Sotalol is concentrated in breast milk, and type III antiarrhythmic properties, is not teratogenic, and its use has not with milk levels several-fold higher than those in maternal plasma, so been associated with fetal growth close monitoring for bradycardia, restriction. Its use near birth has been associated with newborn bradycardia. hypotension, respiratory distress, and hypoglycemia is advised. Adenosine No evidence of increased risk of No information. Because of very short teratogenesis or increased risk of adverse fetal/neonatal effects. half-life, it is unlikely to have any adverse effects on the neonate. Digoxin No evidence of increased risk of The AAP considers digoxin compatible teratogenesis or increased risk of adverse fetal/neonatal effects. with breastfeeding. Verapamil No evidence of increased risk of The AAP considers verapamil teratogenesis or increased risk of adverse fetal/neonatal effects. compatible with breastfeeding. Procainamide No evidence of increased risk of The AAP classifies procainamide as teratogenesis or increased risk of compatible with breastfeeding. https://www.uptodate.com/contents/ventricular-arrhythmias-during-pregnancy/print 23/25 7/6/23, 3:34 PM Ventricular arrhythmias during pregnancy - UpToDate adverse fetal/neonatal effects. However, the long-term effects of exposure in the nursing infant are unknown, particularly with respect to potential drug toxicity (eg, development of antinuclear antibodies and lupus-like syndrome). Quinidine No evidence of increased risk of The AAP considers quinidine teratogenesis. In therapeutic doses, the oxytocic properties of quinidine compatible with breastfeeding. have been rarely observed, but high doses can produce this effect and may result in preterm labor or abortion. Flecainide Developmental toxicity has been noted The AAP considers flecainide in animals, but there is limited information on human risk from early compatible with breastfeeding. pregnancy exposure. This risk appears to be low when used for refractory fetal arrhythmia. It may be the treatment of choice for tachycardia in hydropic fetuses. AAP: American Academy of Pediatrics. Adapted from: Briggs GG, Freeman RK, Ya e SJ. Drugs in Pregnancy and Lactation, 8th edition. Philadelphia: Lippincott Williams & Wilkins. Graphic 50716 Version 8.0 https://www.uptodate.com/contents/ventricular-arrhythmias-during-pregnancy/print 24/25 7/6/23, 3:34 PM Ventricular arrhythmias during pregnancy - UpToDate Contributor Disclosures Louise Harris, MBChB No relevant financial relationship(s) with ineligible companies to disclose. Sing- Chien Yap, MD, PhD Grant/Research/Clinical Trial Support: Medtronic [Ventricular arrhythmias]. Consultant/Advisory Boards: Boston Scientific [Ventricular arrhythmias]. All of the relevant financial relationships listed have been mitigated. Candice Silversides, MD, MS, FRCPC No relevant financial relationship(s) with ineligible companies to disclose. Hugh Calkins, MD Grant/Research/Clinical Trial Support: Adagio Medical [Atrial fibrillation]; Boston Scientific [ARVC]; Farapulse [Atrial fibrillation]; Medtronic [Atrial fibrillation]. Consultant/Advisory Boards: Abbott [Atrial fibrillation]; Atricure [Atrial fibrillation]; Biosense Webster [Catheter ablation]; Boston Scientific [ARVC and atrial fibrillation]; Medtronic [Atrial fibrillation]; Sanofi [Atrial fibrillation]. Other Financial Interest: Atricure [Lecture honoraria]; Biosense Webster [Lecture honoraria]; Boston Scientific [Lecture honoraria]; Medtronic [Lecture honoraria]. All of the relevant financial relationships listed have been mitigated. Heidi M Connolly, MD, FACC, FASE No relevant financial relationship(s) with ineligible companies to disclose. Nisha Parikh, MD, MPH No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/ventricular-arrhythmias-during-pregnancy/print 25/25