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ACCME American Board of Internal Medicine (ABIM) 14/Fetal growth restrictions (FGR) should not limit the use of beta blockers (propranolol, metoprolol, nadolol) when clinically appropriate.(1,3)

ACCME American Board of Internal Medicine (ABIM) 15/Not all beta blockers pose the same risk for FGR. Atenolol is not recommended in pregnancy as it is associated with the highest risk for FGR among beta blockers. Serial fetal ultrasound can be used for fetal monitoring.(3)

ACCME American Board of Internal Medicine (ABIM) 16/The Heart Rhythm Society Consensus Statement summarizes arrhythmia drug safety during pregnancy and lactation for commonly used cardiovascular medications.(1)

ACCME American Board of Internal Medicine (ABIM) 17/ Electrical cardioversion or defibrillation can save lives during emergencies and should not be avoided due to concerns about pregnancy or potential harm to the fetus. Cardioversion is effective and safe during pregnancy.(1)

ACCME American Board of Internal Medicine (ABIM) 18/When placing electrode pads or defibrillator paddles in a pregnant patient, avoid breast tissue to maximize current delivery to the heart. The sterno-apical position is recommended for ventricular arrhythmia.(1)

ACCME American Board of Internal Medicine (ABIM) 19/The antero-posterior placement is recommended for atrial arrhythmia and can also be used after unsuccessful attempts with a sterno-apical vector.(1)

ACCME American Board of Internal Medicine (ABIM) 20/The lifetime risk of malignancy from fetal radiation exposure during cardiac procedures is negligible. Newer technologies enable cardiac ablations and device implants with little to no fluoroscopy.(1)

ACCME American Board of Internal Medicine (ABIM) 21/In pregnant patients requiring anesthesia for cardiac interventions, physiologic changes during pregnancy necessitate modifications in anesthesia approaches.(1)

ACCME American Board of Internal Medicine (ABIM) 22/Modifications of induction agents, neuromuscular blocking and reversal agents, and other medications may be required to prevent QT interval prolongation.(1)

ACCME American Board of Internal Medicine (ABIM) 23/Early pain control during labor is crucial as increased sympathetic activity from pain can trigger arrhythmias (e.g., long QT syndrome and catecholaminergic polymorphic ventricular tachycardia), arrhythmias due to automaticity, and enhanced AV node conduction.(1)

ACCME American Board of Internal Medicine (ABIM) 25/The benefit-risk balance of antiarrhythmic medications use during lactation should be determined case by case. Shared decision-making with a detailed discussion of benefits and risks is essential. Educate patients on signs of toxicity in newborns and infants.(1)

26/Safety in lactation is determined by concentration in breast milk. Nadolol, with low protein binding, can be heavily excreted into breast milk and accumulate in infants. Decision should be made based on underlying clinical pathology.(1)

27/Amiodarone is a last resort in pregnant and breastfeeding women with life threatening arrhythmias due to concerns about fetal and neonatal toxicity.(1)

28/Arrhythmia care in pregnancy requires a multidisciplinary team and shared decision-making.(1)

29/ Hemodynamically significant arrhythmias require most effective therapy available (cardioversion, antiarrhythmics, catheter ablation) with fetal monitoring & measures to minimize radiation.(1)

30/References

31/Congratulations on completing this learning activity. ACCME, American Board of Internal Medicine (ABIM). Click Here for Accreditation Information and to Claim Credit: bit.ly/MgArrPP

What an amazing presentation today by Dr. Erin Michos - Director of ⁦Johns Hopkins Cardiology⁩ CV Health Program & Associate Director of ⁦Johns Hopkins Ciccarone Center⁩ - Dr. Michos has been a national leader in Preventive 🫀 for 2 decades.

Thrilled to host health Equity Scholars Jesse Medina, MD and Mickias Tegegn, MD at #NLASessions at National Lipid Association Miami!! The future looks bright!! #LipidLovers

CVSA Council Linda Shore Danny Muehlschlegel, MD, MMSc MBA Jessica Yu Rove Kimberly Howard-Quijano Pavan Atluri Jo Chikwe Abe