Incidence of Arrhythmias in Normal Pregnancy and Relation to Palpitations, Dizziness, and Syncope

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Abstract

We assessed the relation between symptoms and cardiac arrhythmias in 110 consecutive pregnant patients without evidence of heart disease referred for evaluation of palpitations, dizziness, and syncope (study group) and in 52 consecutive patients referred for evaluation of an asymptomatic functional precordial murmur (control group). Both groups had a high incidence of arrhythmias on Holter monitoring with atrial premature complexes (APCs) of 56% in the study group and 58% in the control group, >100 APCs in 7% and 4% of the patients, respectively, and isolated ventricular premature complexes (VPCs) in 59% and 50%, respectively. The number of isolated VPCs was higher and >50 VPCs/hour were seen in more patients in the study group (3,235 ± 6,397 vs 678 ± 3,358 beats/24 hours p <0.05 and 22% vs 2% p = 0.03). Similarly, the incidence of multifocal VPCs was higher in the study patients (12% vs 2%, p <0.05). There was no correlation between the incidence of both VPCs or APCs and symptoms, and only 10% of symptomatic episodes were accompanied by the presence of arrhythmias. Repeated Holter monitoring 6 weeks postpartum in 9 women with multiple premature contractions during pregnancy (9,073 ± 9,210/24 hours) showed a substantial reduction to 1,345 ± 1,997/24 hours (p <0.05). Thus, this study confirms an increased incidence of arrhythmias during normal pregnancy. These arrhythmias consist mostly of APCs and VPCs. The number of simple and multifocal VPCs is higher in patients presenting with symptoms of palpitations, dizziness, or syncope; however, there is no correlation between the incidence of arrhythmias and symptoms, and only 10% of symptomatic episodes were accompanied by the presence of arrhythmias.

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Patient Population

We studied 110 consecutive pregnant women referred to the High Risk Obstetrical Clinic at the LAC at USC Medical Center for complaints of palpitations, dizziness, presyncope, and/or syncope (study group.) The patients had the following clinical characteristics: their ages ranged from 15 to 42 years (mean 27 ± 7), mean gravidity was 3 ± 2 (range 1 to 13), and mean parity 2 ± 2 (range 0 to 12). Ninety-seven patients were Hispanic (88%), 7 were black (6%), 3 were white (3%), and 3 were Asian (3%).

Results

The study groups' symptoms and reasons for referral were palpitations in 87% of cases, dizziness in 13%, and presyncope or syncope in 6% (Table 1). Four percent had frequent ventricular premature complexes (VPCs) on their 12-lead electrocardiogram and an additional 4% had a history of supraventricular tachycardia (SVT) or frequent VPCs.

Comparing the main symptoms (palpitations, dizziness, and syncope) between the study group and the control patients (Table 2) revealed no significant differences

Discussion

This study demonstrates a high incidence of arrhythmias, mostly ventricular ectopic activity, in young healthy women presenting with symptoms of palpitations, dizziness, or syncope during their pregnancy. Our findings, however, failed to show a positive relation between symptoms and ectopic activity. The presence of arrhythmias could be documented in only 10% of symptomatic episodes. The cause for symptoms in most cases remains, therefore, unclear and their presence during normal pregnancy is

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