Z Geburtshilfe Neonatol 2015; 219 - P04_8
DOI: 10.1055/s-0035-1566609

Supraventricular tachycardia with aberrancy, first diagnosed on the first day postpartum. A case report

V Kiver 1, A Bartens 1, W Henrich 1, A Nonnenmacher 1
  • 1Charité Universitätsmedizin Berlin, Campus Mitte, Geburtsmedizin, Berlin, Germany

Introduction: Due to the usually healthy clientele in obstetrics any new-onset arrhythmias are rare. The association between increased risk of supra-ventricular/ventricular tachyarrhythmia (SVT/VT) and pregnancy is a topic of controversy. Nevertheless it seems likely that female sex and possibly pregnancy are pro-arrhythmic factors. SVTs are the most common arrhythmias in pregnancy and are usually under-diagnosed due to their benign nature and unspecific symptoms.

Case report: A 35 year old healthy primigravida had an intraamniotic infection and a secondary caesarean section in 40 + 5 weeks of gestation after a uneventful pregnancy. On the 1st day postpartum the mother complained of nausea, general unease and discomfort. The vitals showed BP 100/60 mmHg, SaO2 98% and pulse 230bpm. The urgent ECG showed a wide QRS-complex tachycardia. It was not possible to differentiate between a VT and a SVT at this instant. The hemodynamically stable and responsive patient was treated with i.v. Magnesium and Metoprolol and transferred to an intensive care unit. After 30 minutes and two failed attempts at cardioversion, treatment with iv. Adenosine was successful in establishing sinus-rhythm. The patient history revealed 4 – 5 self-limited episodes of palpitations on physical exertion, but no symptoms during pregnancy. An Echo showed no signs of structural cardiac disease. The patient experienced 3 more self-limited episodes during the day and an AV-node re-entry tachycardia with aberrancy was diagnosed. The patient did not wish further evaluation and treatment with electrophysiological studies.

Discussion: In an acute setting the DD of a wide QRS-complex tachycardia is often difficult. This case is of note because our Patient did not present with the classical symptoms of arrhythmias. Nausea and generalized discomfort less than 12 hours after a caesarean section seem usually not alarming, but even such unspecific symptoms warrant further examination in postpartum patients.