Table 2 Diagnostic modalities used in arrhythmia diagnosis
  • Echocardiography

This should be considered an integral part of the investigation of any pregnant patient with proven arrhythmia to diagnose structural and functional heart disease
  • Exercise ECG

This can be reasonably carried out during pregnancy providing exercise is not contraindicated for obstetric reasons. Care should be taken not to exceed the woman’s normal exercise capability and the test should be stopped if hypotension develops as this may impair placental perfusion
  • Tilt-table testing

While there has been experience of this in pregnancy, it is usually possible to delay this investigation until after pregnancy. It is also difficult to do beyond 24 weeks as women are unable to lie flat on their backs as the gravid uterus impedes inferior vena cava flow
  • Pharmacological testing

A pharmacological challenge may provide important diagnostic information, particularly in narrow complex tachycardia. Adenosine has been widely used in pregnancy though predominantly for arrhythmia termination. There is no reported experience of ajmaline or flecainide challenge for Brugada syndrome in pregnancy; however, flecainide has safely been used in pregnancy
  • Electrophysiological studies

This is rarely required in pregnancy as the arrhythmia can usually be managed pharmacologically until after delivery