Troubles du rythme cardiaque au cours de la grossesse et de l'accouchement

Pregnancy may predispose the mother to new-onset arrhythmias or exacerbation of previously known ones. This can be explained by cardiovascular changes occurring during pregnancy, including plasma volume expansion, increase in cardiac output and heart rate, heterogeneous ventricular hypertrophy in response to the increase in cardiac workload, and the resulting electrophysiological consequences, especially prolonged repolarisation and increase in spatial dispersion. Cardiac arrhythmias during pregnancy are of various origins. With decreasing frequency, one can cite sinus tachycardia, sinus bradycardia, sinus arrhythmia, premature atrial or ventricular contractions, paroxysmal supraventricular tachycardia, cardiac arrest, atrioventricular block, atrial fibrillation or flutter, ventricular tachycardia or fibrillation. The diagnosis is based on a detailed history including symptoms, activities at the time of onset, possibly predisposing factors on one hand, and electrophysiological evaluation by all useful modes of electrocardiography, and echocardiography on the other hand. Arrhythmias in the absence of structural heart disease are usually benign. Therefore, reassurance and avoidance of stimulants is sufficient in most of the time. Drug therapy may be required in case of symptomatic troublesome arrhythmias. Betablockers are the first-line agents, but other medications can also be given. A multidisciplinary approach is essential to ensure the best maternal and foetal prognosis, by a comprehensive antepartum, intrapartum, and ongoing postpartum care for the pregnant woman.