SVT in Pregnancy — EECC MCQ

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ModerateArrhythmia & ElectrophysiologySVT in PregnancyEECC

A 30-year-old pregnant woman (28 weeks gestation) with a structurally normal heart presents with symptomatic paroxysmal SVT unresponsive to vagal manoeuvres. Adenosine has failed to terminate the tachycardia. What is the safest next pharmacological option?

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Correct answer: D — DC cardioversion

In pregnancy, if adenosine (which is safe in pregnancy) fails to terminate SVT, DC cardioversion is recommended as the next step (Class I, safe at all stages of pregnancy per 2025 ESC CVD in Pregnancy Guidelines). Intravenous verapamil may be considered with caution but carries risks of hypotension. Amiodarone is avoided due to fetal thyroid toxicity. Flecainide may be used for prophylaxis but IV use in pregnancy has limited safety data. DC cardioversion is safe, effective, and does not harm the fetus. Fetal monitoring should be performed before and after the procedure.

Reference: ESC (2025): Guidelines for CVD in Pregnancy