Significant cardiac dysrhythmias are rare in pregnancy. However, medications such as lidocaine, digoxin, and procainamide may be used for the usual indications and in the usual therapeutic doses and have not been shown to be harmful to the fetus. Use of b blockers for acute tachydysrhythmias has not been associated with adverse neonatal outcomes,3 but maintenance b blockers are a group C drug and should be prescribed in consultation with a cardiologist and obstetrician. Verapamil has been shown to be effective in the conversion of supraventricular tachycardia to sinus rhythm without adverse fetal effects. Anticoagulation using unfractionated or low-molecular-weight heparin for the treatment of atrial fibrillation in pregnancy appears safe and may be used if the patient meets the criteria for anticoagulin described for nonpregnant patients. Cardioversion also appears safe for the fetus. 4 The presence of an artificial pacemaker has not been shown to affect the course of pregnancy.5
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