Journal of Innovative Clinical Trials and Case Reports

Abstract

Introduction: The physiological state of pregnancy causes changes to the autonomic nervous system which can lead to serious complications such as the onset of a cardiac arrhythmia. This arrhythmia can be potentially harmful to both the mother and the foetus. This arrhythmic event is all the more common when there is a contributing factor such as the presence of an accessory pathway. We report the case of a 28-year-old patient, 32 weeks pregnant, who was admitted to our department with poorly tolerated atrial fibrillation presenting with Wolff-Parkinson-White syndrome.

Clinical Presentation: This is a 28-year-old woman, 32 weeks pregnant, admitted for palpitations. Physical examination revealed a blood pressure (BP) of 80/55 mmHg and a heart rate of 203 beats per minute. An electrocardiogram revealed a fine QRS tachycardia at 280 beats per minute, suggesting atrial fibrillation. A diagnosis of cardiac arrest was performed, leading to the delivery of an external electrical shock at 200 joules, which restored sinus rhythm with a heart rate of 98 beats per minute; a P-R interval of 10/100s and a widening of the ascending limb of the QRS complex were noted. The patient was started on labetalol 200 mg once daily.

Conclusion: Atrial fibrillation is the most common arrhythmia, particularly when it occurs in a patient with an accessory pathway. This arrhythmia poses a real problem-prognosis depending on its clinical presentation in a pregnant woman, as it may be life-threatening for both the mother and the foetus.