Table 3 Antiarrhythmic drugs
DrugsSafety profileListed complicationsBreast feeding
AdenosineSafe to use in pregnancy with no detectable effect on fetal cardiac rhythmPregnant women may respond to lower doses due to a reduction in adenosine deaminaseSafe as short half life
AtropineUnknown but has been used for resuscitationInsufficient dataUnknown
AmiodaroneOnly for short term use in emergenciesIf prolonged use; fetal hypo- and hyperthyroidism, goitre, IUGR, prematurityAvoid
β-blockersAvoid atenolol in first trimester because of concern over IUGRIUGR, bradycardia, apnoea, hypoglycaemia, hyperbilirubinaemiaSafe
DigoxinGood safety profileMiscarriage and fetal death in toxicitySafe
DiltiazemToo little experience to commentSkeletal abnormalities, IUGR, fetal deathUnknown
DisopyramideToo little data to recommend regular usePremature uterine contractionsUnknown
FlecainideLimited literature for treatment of maternal arrhythmias; however, maternal ingestion used to treat fetal SVTInsufficient data but no reported significant complications. Concerns over its pro-arrhythmic potential in fetus have limited its use in pastUnknown
LignocaineGoodFetal distress may occur in fetal toxicitySafe
QuinidineGood safety profile in pregnancy; however, not used because of concern over safety profile in non-pregnant womenRarely, mild uterine contractions, premature labour, neonatal thrombocytopenia, fetal VIIIn damageSafe
ProcainamidePossibly as safe as quinidine short term in pregnancyChronic use may be associated with lupus-like syndrome, gastrointestinal disturbance, hypotension, agranulocytosisSafe
PropafenoneUnknownInsufficient dataUnknown
SotalolSafeTransient fetal bradycardiaSafe
VerapamilSafe (1st choice class IV drug)Rapid injection may cause maternal ↓ BP and fetal distressSafe

  • BP, blood pressure; IUGR, intrauterine growth restriction; SVT, supraventricular tachyarrhythmia.