PDF(Pubmed)
Abstract：
The incidence of atrial fibrillation (AF) during pregnancy increases with maternal age and with the presence of structural heart disorders. Early diagnosis and prompt therapy can considerably reduce the risk of thromboembolism. The therapeutic approach to AF during pregnancy is particularly challenging, and the maternal and fetal risks associated with the use of antiarrhythmic and anticoagulant drugs must be carefully evaluated. Moreover, the currently used thromboembolic risk scores have yet to be validated for the prediction of stroke during pregnancy. At present, electrical cardioversion is considered to be the safest and most effective strategy in women with hemodynamic instability. Beta-selective blockers are also recommended as the first choice for rate control. Antiarrhythmic drugs such as flecainide, propafenone and sotalol should be considered for rhythm control if atrioventricular nodal-blocking drugs fail. AF catheter ablation is currently not recommended during pregnancy. Overall, the therapeutic strategy for AF in pregnancy must be carefully assessed and should take into consideration the advantages and drawbacks of each aspect. A multidisciplinary approach with a \"Pregnancy-Heart Team\" appears to improve the management and outcome of these patients. However, further studies are needed to identify the most appropriate therapeutic strategies for AF in pregnancy.
摘要：
妊娠期间房颤（AF）的发生率随着母亲年龄和结构性心脏病的存在而增加。早期诊断和及时治疗可以大大降低血栓栓塞的风险。妊娠期间房颤的治疗方法尤其具有挑战性，必须仔细评估与使用抗心律失常和抗凝药物相关的孕产妇和胎儿风险。此外，目前使用的血栓栓塞风险评分对于妊娠期卒中的预测尚待验证.目前,对于血流动力学不稳定的女性,电复律被认为是最安全和最有效的策略.β-选择性阻滞剂也被推荐作为心率控制的首选。抗心律失常药物如氟卡尼，如果房室结阻滞药物失效,应考虑使用普罗帕酮和索他洛尔进行节律控制.目前不建议在妊娠期间进行AF导管消融。总的来说,必须仔细评估妊娠期房颤的治疗策略,并考虑各方面的优缺点.“妊娠心脏团队”的多学科方法似乎可以改善这些患者的管理和预后。然而,需要进一步的研究来确定妊娠期房颤最合适的治疗策略.
