Arrhythmia in pregnancy

[Krisydney]

I am a 35-year old female and I am 5-1/2 months pregnant.  I have two healthy daughters (age 19 years old and 3-1/2 years old).

I have had a fast heartbeat for at least the last 10 years.  My resting heartbeat is 180-200 bpm off and on throughout the day.  For the past six years, I have been misdiagnosed as having Mitral Valve Prolapse.

In February 2001, I was diagnosed with supraventricular Tachycardia (rapid tachyarrhythmia) by a cardiologist.  At the time I was diagnosed, I was already one month pregnant.  My cardiologist recommended the ablation procedure but it obviously cannot be done until after the baby is born.

My question is - I am currently NOT taking any medication for this condition because I'm not sure how the fetus would be affected by the medication.  Now, I'm worried that I may be affecting the oxygenated blood to the baby by not treating this through medication.  I'm not sure I'm doing the best thing for my baby by not taking the medicine.  I wish someone could give me advice on the consequences of a rapid heart beat on a fetus vs. the risks involved in taking the medication with the fetus.

Sometimes my arrhythmia episodes last only a few minutes and sometimes they last for hours.  During those times, I lay down and try to relax.

I went to the emergency room during my third month of pregnancy and my heart rate was over 200 bpm.  I was given calcium channel blockers through an IV.  I'm scared thinking how that medication may have affected the baby.

I did not have any major difficulties with my last two pregnancies but also I wasn't as aware of the rapid heartbeat because at the time, I thought it was normal.

The only problem I had was in 1997 in labor when my heart rate went to 220 bpm.

Thanks for any information.  I am in the process of getting a second opinion from an electrophysiologist.  I just want to make sure what I am doing is best for my baby.

[CCF-M.D.-CRC]

Dear Krisydney,

In general beta-blocker and calcium channel blocker medications are safe for use in pregnancy.  There is not a great risk to the baby for most arrhythmias but your OB can tell you better if there is a harmful effect from your particular arrhythmia.  The EP doctor can also make medication recommendations and plan follow-up after you have the baby.

[Lyn2]

I had exactly the same problem during my two pregnancies.  In fact, my arrythmia problem wasn't picked up until I was pregnant for the first time.  What my cardiologist explained to me was that beta blockers were pretty benign during pregancy.  Also, that during pregnancy it is not good for your heart to beat above 140bpm.  They seemed to think that this was more important, than the effects from the beta blocker.  I believe at that time I was taking tenormin. I had several doctors, my ob-gyn, cardiologist and nutritionist all who agreed that this was the best way.  My children were healthy and had no problems from the medication.  I too fretted about the consequences when I was pregnant, but it seemed the best of the two choices.  In fact, I was pretty assured that the medication was safe.

I subsequently had an ablation. Now I have a pacemaker and I'm taking amiodarone (an anti-arrythmic).  I am 33.  I wish you all the luck in making this decision.  If you want to talk more let me know and I can give you my email address.

[Rachel]

Hello,

My PSVT and PVCs got much worse during pregnancy.  I was on 120 mg of Verapamil for the last five months and there were no complications.  Of course this is something for you and your doctor to decide.

Good luck and I hope you find some relief soon.

Cheers,
Rachel

PS:  A question to cn -- do you have a pacemaker because of the procedure?

[Lyn2]

Rachel,

The answer is yes, I do have a pacemaker as a result of an ablation.  I wasn't supposed to end up with one, but they always give you that small percentage that you may end up with one after an ablation.  I guess I fit into that group.  I ended up with only an escape rhythm.  My rate was 20-30 bpm with pauses for several seconds.  They did send me home, where I stayed feeling horrible for several weeks before they discovered it was a serious problem.  I ended up in I.C.U. for a couple of weeks.  The pacemaker is not bad, but for some reason with this problem of having too slow a beat, I also can have too fast a rhythm (a-fib and reentrant tachycardia, which I never had before the ablation.  That is why I take amiodarone, coumadin, calcium channel blockers, and dieretics.  

I do remember during my pregnancy though, the cardiologist said do everything you can to keep your heart rate down.  Of course, there is only so much control you can have, but I wasn't allowed to walk any distance, I had to use a wheelchair.

[tachy]

HI CN  I WAS WONDERING ARE YOU TAKING THE AMIODARONE FOR VENTRICULAR ARRHYTHMIAS OR SUPRAVENTRICULAR ARRHTHMIAS?  DO YOU PLAN TO HAVE ANY MORE CHILDREN, THE REASON I ASK IS BECAUSE YOU ARE TAKING A MEDICATION THAT CARRIES SERIOUS ORGAN TOXICITY SIDE EFFECTS AND IT WILL HARM THE FETUS.  YOU ARE TAKING IT AT SUCH A YOUNG AGE.  I AM A CARDIAC NURSE AND HAVE HAD MULITPLE ABLATIONS FOR IST, AND AUTOMATIC ATRIAL TACH, WITH OUT SUCCESS AND HAVE TRIED ALMOST EVERY ANTI ARRHTHMICS.  NOW I HAVE A PACEMAKER AND TAKE HIGH DOSES OF CALCIUM CHANNEL BLOCKERS.  I HAVE SEEN WHAT CAN HAPPEN TO PEOPLE WHO TAKE AMIODARONE AND IT IS NOT PRETTY, I HAD A PT ONLY TAKE IT FOR 3 YEARS AT 200MG A DAY AND HE STARTED HAVING ALL KINDS OF PROBLEMS WITH HIS THYROID SO HIS DR. TOOK HIM OFF OF THE MED, HE WAS 33, AND HE HAD TO HAVE SURGERY AND TAKE OTHER MEDS TO TRY AND CORRECT THE PROBLEMS THE AMIO CAUSED.  I WAS PUT ON IT BY ONE OF MY EP DRS. BUT NOT WITH OUT A FIGHT  THANK GOD IT DIDNOT WORK AT THE DOSE I WAS ON BECAUSE MY REGULAR CARDIOLOGIST TOOK ME OFF OF IT  AND SAID NEVER AGAIN.  HE ONLY PRESCRIBES IT TO MUCH!!! OLDER PTS. NEVER THE YOUNGER ONES.  SO THATS WHY I ASKED WHAT ARRHTHMIA DO YOU HAVE VT IS A PRETTY SERIOUS ONE AND AMIO IS GREAT FOR IT.  THE DRUG IS GREAT BUT THE SIDE EFFECTS ARE HORRIBLE.  I JUST WANTED TO TELL YOU A LITTLE ABOUT THE MEDICATION.   HOPE ALL WORKS OUT FOR YOU,  TACHY

[tachy]

i am sorry after i posted my comment you answered some of my questions.  there is another great new drug for a fib and it is called tykosin, it did not keep my rate down, i had to take high doses of calcium channel blockers with it but because of the several ablations my average hr was in the high 40 to low 50 and i could not tolerate the meds that help to prevent the fast break throughs.  i wish you would talk with your dr. about the amiodarone, i just know what it can do and you are so young and have a family to take care of.  i wish you luck.   tachy
oh the reason it did not work we dont know but i have automatic atrial tach and it is a very difficult one to treat but that med was made for people with a fib

[Lyn2]

Tachy,

I have to say, it is so funny to have you write to me 5 seconds after reading what you wrote in the patient support forum for pacemaker patients.  I really cant believe it.  I swear, I was just about to write you and tell you my situation, because I became a bit alarmed about what you were saying.  Being a cardiac nurse would indeed give you that experience.  Thank you for bringing it to my attention.  It is not as though, I was not aware of the side effects, I just didn't know how harmful they can be.  Your point of being too young does make sense.  I suffer from a number of rhythm problems, and have been told that it is either v-tach or a-fib with rapid ventricular response.  My rate gets up to about 300 and I lose my blood pressure, seen by doctors.  

I have been on the gamut of anti-arrythmics with no relief, this is the first that has lessened the incidence of arrythmia.  Right now I have been told that my liver enzymes are elevated, I am beginning to suffer neurological symptoms, and I have such a severe reaction to the sun that I can't go outside if it is sunny, and that's with all the protection in the world.  I get blisters and severe itching and pain in my joints.  Well, gosh I didn't mean to give a grocery list.  I just wonder if it is all attributed to that medication.  My other option is to have my AV node ablated.  To tell you the truth I really don't know where I'm at with this right now.  I just feel like I've been through so much, that I cant bear even going to the doctor, let alone trying to come up with an alternative.  Perhaps, we will meet up again on this forum or the other. I haven't participated in that one yet but I intend to.

Thanks so much!!

[Lyn2]

Tachy,

When I was hospitalized this past winter for a heart cath. they decided at that time to try me on the tykison, thankfully I was in the hospital because I developed Long QT, and was not even allowed to get out of bed for a few days because my EKG was so abnormal.  That was when they initiated the amiodarone.

Thanks again!

[tachy]

that is wild that we were both on the internet at the same time.  those sided effects are what the amiodarone can do i sun burned bad and that is a high risk because it makes you photosensitive there is also corneal microdeposits so tell your eye dr. you are on this, altered liver enzymes a multitude of centeral nervous system side effects ,severe pulmonary toxicity you should of had a pulmonary function test before the med to get a base line and one periodically, if you are out doors too much you will become a smurf no kidding you can turn a greyish blue color, you can also have trouble with your thyroid.  have you asked your dr. about mexitil which is also used for v tach and if you are having trouble with v tach and loosing your bp sounds like you could use an automatic internal defibrilator they have the aicd and pacer combos (aicd is the defibrilator that is hooked up to your heart internally and senses it just as the pacer does and if a serious ventricular rhythm shows its nasty head it will fire just like they do when they put the paddles on you in the hospital except this is inside and the jules arent as high an i usually scares the peas out of people when it fires for the first time.  talk with your dr. about your options.  rythmol, betapace they all have their side effects but amio so far is the worse.

did they lower the dose of your tykosin and try it again when i got my first does my qt went from 400 to 600 and the resident freaked out put the crash cart in my room,(i was the first person to get this med in the baltimore/washington area) and he said no more drug for you i said no you decrease it by half and if it happens again then no more drug for me so he called the ep dr. and that is what they did but it didn't keep the P.A.T.'s under control and i started to have frequent ugly pvc's the one's you hear of r on t phenonomen (ms) which can lead to v tach easily..  so now i have the pacer and i am taking 360mg of tiazac and 240mg of verapamil a day for rate control and 0.2mg of floinef a day to keep a bp and now because  of the calcium channel blockers i have gerd because they relax the les. which is the lower end of the esphogus which is now leading to esophageal spasms so i have to take prevacid and i use nitro for the spasms.  

we will not do a av node ablation because the pacer will keep my ventricals beating at a normal pace but it will not cure the top chamber it will still do its thing but now not get through to the ventricals at that beat so my two chambers will beat independent of one another at times and if your top chamber is beating faster than you bottom there is a possibility it will try to force blood against a closed chamber and that blood will need to go some where and others have said they feel like it is a wave flowing up there neck and c/o discomfort and dizziness. but you have to do what you have to do and you will pobly still need to take medications to try and keep the atrium under control and if you have a fib you will still have it just now your ventricals will be beating via the pacemaker and your atrium could still be beating chaoctically.  but i which you would reconsider the amiodarone.  some of the side effects stop when the med is stopped if damage hasn't settled in, but it can take a while because it has a very long half life and it could take up to 4 months.  please please talk with your dr. you need thyroid studies, liver functions, eye exams and lung function tests.  take care my email address is ***@**** and in a week it will be ***@**** my name is inga but if you have gone to that wed site implantable .com i am not the same inga i use tachy.  email me any time and you can ask me anything and i will do my best to help take care of your self.  tachy

[tachy]

i just wanted to tell you to hang in there and that i will be praying for you and your family i understand your frustration,  in the past 3 years i have had 3 ablations a multitude of meds. frequent hospitalizations, and a pacemaker, it made me feel like a million bucks, but then my hip pain started to get worse and my joints started to get looser and found out i have a rare connective tissue disorder called ehlers danlos syndrome my skin is so fragil i which we knew this before the pacer because it healed with a very ugly scar, i feel like i am falling apart and i am trying to reconsider my career i want to stay a cardiac nurse because that is my passion but i know i want be doing floor nursing for much longer.  my pcp said i should become a phamacist because of my vast knowledge of medications.  i dont know maybe a nurse researcher, what ever i love being a pt advocate.  hang in there the good lord doesn't give us more than we can handle, i also found out by my cardiologist he would like me to consider adoption be cause the meds i am on are too much and we cant modify them because then my hr would be up and that would be harmful too.  but i have finally come to terms and adoption is not a bad idea it want make me any less of a mom, and i wouldn't be passing this all on to my children the way it has been passed down in my family.   take care and keep in touch  tachy

[Krisydney]

Thank you for responding to my question.  I am gathering all of my information and bringing it with me to my doctor.  Bless you.