Published: 2021-09-27

A rare case of recurrent paroxysmal supraventricular tachycardia in pregnancy managed with adenosine, a wonder drug

Snehal W. Pakhale, Sadhna D. Gupta, Anita Bansal, Angela Sehra


Paroxysmal supraventricular tachycardia (PSVT) is the most common sustained arrhythmia during pregnancy and a challenging situation due to lack of evidence based guidelines. About 50% of PSVT, who fail to respond to vagal maneuvres, responds to therapies as pharmacologic agents as adenosine and electrocardioversion. We reported a case of 29 years old primigravida women with no organic heart disease who presented at 21 weeks of period of gestation with complaints of palpitations and shortness of breath. Her ECG revealed PSVT for which she received adenosine as anti-arrhythmic for conversion to sinus rhythm. She was started prophylactically on tablet metoprolol 25 mg twice daily, as advised by cardiologist. In third trimester, she had recurrent episodes of PSVT for which she received adenosine in emergency department. She delivered a healthy female baby by an elective caesarean section done under spinal anesthesia. Fortunately, her intraoperative and postpartum was uneventful with no recurrence of PSVT during hospital stay. She was discharged on day 4 of caesarean section on tablet metoprolol 12.5 mg twice daily and followed in postpartum period for complications. To summarize, PSVT occurring during pregnancy, labour or at caesarean section is not uncommon. Treatment remains a challenge though, as clinical decision must be tackled with appropriate consideration of both maternal and fetal factors. So, multi-disciplinary approach is needed for treatment including obstetrician, cardiologists, physician and neonatologists. Our case highlighted the necessity of keeping anti-arrhythmic drugs such as adenosine readily available on the labour ward.


Recurrent paroxysmal supraventricular tachycardia, Pregnancy, Adenosine, Metoprolol

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McAnulty JH. Arrhythmias in pregnancy. Cardiol Clin. 2012;30(3):425-34.

Brodsky M, Doria R, Allen B, Sato D, Thomas G, Sada M. New-onset ventricular tachycardia during pregnancy. Am Heart J. 1992;123:933-41.

Tan H. Treatment of tachyarrhythmias during pregnancy and lactation. Eur Heart J. 2001;22(6):458-64.

Tromp CHN, Nanne ACM, Pernet PJM, Tukkie R, Bolte AC. Electrical cardioversion during pregnancy: safe or not? Neth Heart J. 2011;19(3):134-6.

Adamson DL, Nelson‐Piercy C. Managing palpitations and arrhythmias during pregnancy. Heart. 2007;93(12):1630-6.

Warnes CA, Group BP, Warnes CI. Library of Congress Cataloging-in-Publication Data. New York: Berkley Books; 2015.

Mason BA, Ricci-Goodman J, Koos BJ. Adenosine in the treatment of maternal paroxysmal supraventricular tachycardia. Obstet Gynecol. 1992;80:478-80.

Robins K, Lyons G. Supraventricular tachycardia in pregnancy. BJA Br J Anaesth. 2004;92(1):140-3.

Agrawal R, Shintre H, Rani B. A rare case of supraventricular tachycardia during pregnancy and successful management in crisis situation with electrical cardioversion and radiofrequency ablation. J Obstet Gynaecol India. 2016;66(2):594-7.

Orejarena LA, Vidaillet H, DeStefano F, Nordstrom DL, Vierkant RA, Smith PN, et al. Paroxysmal supraventricular tachycardia in the general population. J Am Coll Cardiol. 1998;31(1):150-7.

Ghosh N, Luk A, Derzko C, Dorian P, Chow CM. The acute treatment of maternal supraventricular tachycardias during pregnancy: a review of the literature. J Obstet Gynecol Can. 2011;33(1):17-23.

Chang SH, Kuo CF, Chou IJ, See LC, Yu KH, Luo SF, et al. Outcomes associated with paroxysmal supraventricular tachycardia during pregnancy. Circulation. 2017;135(6):616-8.

Gowda RM, Khan IA, Mehta NJ, Vasavada BC, Sacchi TJ. Cardiac arrhythmias in pregnancy: clinical and therapeutic considerations. Int J Cardiol. 2003;88(2-3):129-33.

Merino JL, Perez-Silva A. Tachyarrhythmias and pregnancy. J Cardiol. 2011;9(31).

Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart rhythm society. J Am Coll Cardiol. 2016;67(13):27-115.

Ferrero S, Colombo BM, Ragni N. Maternal arrhythmias during pregnancy. Arch Gynecol Obstet. 2004;269(4):244-53.

Wang YC, Chen CH, Su HY, Yu MH. The impact of maternal cardioversion on fetal haemodynamics. Eur J Obstet Gynecol Reprod Biol. 2006;126(2):268-9.

Practice Update. Fact sheet: MY APPROACH to the pregnant patient with a supraventricular tachycardia. Available at: Accessed on 21 May 2021.

Sandström B. Adrenergic beta-receptor blockers in hypertension of pregnancy. Clin Exp Hypertens B. 1982;1(1):127-41.

Kleinman CS, Copel JA, Weinstein EM, Santulli TV, Hobbins JC. Treatment of fetal supraventricular tachyarrhythmias. J Clin Ultrasound JCU. 1985;13(4):265-73.

Schroeder JS, Harrison DC. Repeated cardioversion during pregnancy. Treatment of refractory paroxysmal atrial tachycardia during 3 successive pregnancies. Am J Cardiol. 1971;27(4):445-6.

Szumowski L, Szufladowicz E, Orczykowski M, Bodalski R, Derejko P, Przybylski A, et al. Ablation of severe drug-resistant tachyarrhythmia during pregnancy. J Cardiovasc Electrophysiol. 2010;21(8):877-82.