Article Text

Download PDFPDF
Managing palpitations and arrhythmias during pregnancy
  1. Dawn L Adamson1,
  2. Catherine Nelson-Piercy2
  1. 1
    Department of Cardiology, Hammersmith Hospital NHS Trust, London, UK
  2. 2
    Guy’s & St Thomas’ Foundation Trust, St Thomas’ Hospital, London, UK
  1. Dr Catherine Nelson-Piercy, Guy’s & St Thomas’ Foundation Trust, 10th floor Directorate Office, North Wing, St Thomas’ Hospital, Lambeth Palace Rd, London SE1 7EH, UK; catherine.nelson-piercy{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Arrhythmias in pregnancy are common and may cause concern for the wellbeing of both the mother and the fetus. For some mothers the arrhythmias may be a recurrence of a previously diagnosed arrhythmia or the first presentation in a woman with known structural heart disease. In most cases, however, there is no previous history of heart disease, and the new occurrence of a cardiac problem can generate considerable anxiety. The majority of arrhythmias that occur during pregnancy are benign, and simply troublesome; hence, advice about appropriate actions during symptomatic episodes, together with reassurance, is usually all that is required. In the remaining minority of cases, judicious use of antiarrhythmic drugs will lead to a safe and successful outcome for both mother and baby. While there were no documented maternal deaths from primary arrhythmias in the last UK confidential enquiry into maternal mortality,1 9% of cardiac deaths were defined as sudden adult death syndrome, which raises the possibility of death from a primary arrhythmia. In women with known structural heart disease, however, arrhythmia is one of the five independent predictors of having a cardiac event during the pregnancy and should therefore be treated seriously.2


Palpitations are a very common symptom in pregnancy. As cardiac arrhythmias can be identified on Holter recordings in up to 60% of normal people under the age of 40 years, it is not surprising that the antenatal clinic encounters its fair share of palpitations.3 In pregnancy, heart rate (HR) increases by 25%; thus sinus tachycardia, particularly in the third trimester, is not uncommon. Ectopic beats and non-sustained arrhythmia are encountered in more than 50% of pregnant women investigated for palpitations while sustained tachycardias are less common at around 2–3/1000.46

There are well known gender differences in the incidence and risk factors …

View Full Text


  • Both authors also at Department of Obstetric Medicine, Queen Charlottes and Chelsea Hospital, London, UK

  • In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article.