TITLE:
Management of Cardiac Pacemakers in a Pregnant Patient
AUTHORS:
Sonal Grover, Puja Sheth, David E. Haines, Mazhar Khan, Bernard Gonik
KEYWORDS:
Pacemaker, Pregnancy, Anticoagulants, Fetal Monitoring, Electrocardiography, Anesthesia, Antepartum
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.5 No.1,
January
23,
2015
ABSTRACT:
Introduction: Despite the increasing use of permanent cardiac pacemakers
in a younger patient population, there are little data related to pregnancy. We
present our experience in managing a pregnant patient with a pre-existing
pacemaker and review the existing literature to establish management
guidelines. Case: A 27-year-old G1 P0 presented for prenatal care in the first
trimester of pregnancy. She had a past medical history of bradycardia,
hypotension and syncope that required dual chamber cardiac pacemaker placement
6 years earlier, and one episode of left upper extremity venous thrombosis
related to replacement of the pacemaker wire 4 years earlier. In the early
second trimester, the patient began experiencing light-headedness and
breathlessness with exertion. The rate
settings of the pacemaker were increased with resolution of the patient’s
symptoms. The patient underwent primary cesarean section at 39 weeks
gestation with delivery of a healthy term infant. Preoperative anesthesia
consultation was obtained. The postoperative course was uneventful.
Pre-pregnancy pacemaker settings were re-established after the postpartum
period. Discussion: The current literature on managing pregnant patients with
pre-existing pacemakers is quite limited. Such patients require a
multidisciplinary approach to care. Normal physiologic changes in pregnancy may
necessitate rate adjustments. Other than routine thromboprophylaxis, no other
anticoagulation is needed. Route of delivery is generally based on obstetric
indications. During surgery consider using
bipolar electrocautery in place of unipolar electrocautery, to reduce
electromagnetic interference. Also, the placement of the grounding pad should
be as far away from the pacemaker as possible. It should be anticipated that
the patient will return to her baseline cardiac status postpartum and therefore
pacemaker settings can be adjusted accordingly.