H?ufigkeit, Diagnostik und Therapie von Herzrhythmusst?rungen in der Schwangerschaft

Atrial premature beats are frequently diagnosed during pregnancy (PR), supraventricular tachycardia (SVT) less frequently. For acute therapy, electrical DC-cardioversion with 50–100 J is indicated in all unstable patients (pts). In stable SVT, the initial therapy includes vagal maneuvers to terminate breakthrough tachycardias. For short-term management, when vagal maneuvers fail, intravenous adenosine is the drug of first choice and may safely terminate the arrhythmia. Ventricular premature beats are also frequently present during PR and benign in most pts, while life-threatening ventricular tachyarrhythmias (sustained ventricular tachycardia (VT), ventricular flutter (VFlut), ventricular fibrillation (VF)) are observed less frequently. Electrical DC cardioversion is necessary in all pts with a hemodynamically unstable situation and life-threatening ventricular tachyarrhythmias; in hemodynamically stable pts, initial therapy with ajmaline, procainamide or lidocaine is indicated. In pts with syncopal VT, VF, VFlut or aborted sudden death, an implantable cardioverter-defibrillator is indicated. In pts with symptomatic bradycardia, a pacemaker can be implanted using echocardiography at any stage of PR.