Particularities of arrhythmias in pregnancy
During pregnancy, there is a wide array of anatomical, hormonal and
hemodynamic adaptive changes to optimize fetal growth and development.
While healthy women can adapt without significant consequences, in those
with underlying cardiac conditions, these changes may unmask a
previously unknown condition or exacerbate pre-existing illnesses.
The physiological changes include increased plasma volume and fat
accumulation, decreased plasma binding proteins, and increased hepatic
and renal clearance. One of the consequences is pharmacokinetics
modification, altering drug effects in both mother and fetus. Thus, the
use of medications during pregnancy requires a careful evaluation,
balancing fetal and maternal risk-benefit. Available data regarding
drugs’ teratogenicity are limited and primarily based on animal models,
retrospective analyses, advisory boards, or case reports. Only a few
drugs have documented side effects leading to human fetal malformation
or death, yet the medicolegal implications are so severe that drug
manufacturers hardly commit to declaring the safety of a given drug
safety during pregnancy.