The Unexpected Pitter Patter: New-Onset Atrial Fibrillation in Pregnancy

Abstract EN

Background.

Atrial fibrillation is a relatively uncommon but dangerous complication of pregnancy.

Emergency physicians must know how to treat both stable and unstable tachycardias in late pregnancy.

In this case, a 40-year-old female with a cerclage due to incompetent cervix and previous preterm deliveries presents in new-onset atrial fibrillation.

Case Report.

A previously healthy 40-year-old African American G2 P1 female with a 23-week twin gestation complicated by an incompetent cervix requiring a cervical cerclage presented to the emergency department with intermittent palpitations and shortness of breath for the past two months.

EMS noted the patient to have a tachydysrhythmia, atrial fibrillation with rapid ventricular response.

She was placed on a diltiazem drip, which was titrated to 15 mg/hr without successful rate control.

Her heart rate remained in the 130s and the rhythm continued to be atrial fibrillation with RVR.

Digoxin was then added as a second agent, and discussions about the potential risks of cardioversion in pregnancy ensued.

Fortunately, the patient converted to sinus rhythm before cardioversion became necessary.

The digoxin was discontinued; the diltiazem was also discontinued after the patient subsequently developed hypotension.

“Why Should Emergency Physicians Be Aware of This?” New-onset atrial fibrillation is rare in pregnancy but can increase the mortality and morbidity of the mother and fetus if not treated promptly.