Utility of Ambulatory Non-Invasive Rhythm Monitoring in Pregnant Patients with Palpitations and Structurally Normal Hearts

Abstract

Ambulatory Cardiac Monitoring (ACM) is often used to evaluate pregnant patients with palpitations without structural heart disease; however, the diagnostic yield is not well defined. This single-center retrospective cohort study included pregnant patients without structural heart disease evaluated in a tertiary care cardio-obstetrics clinic between June 2023 and June 2024. The primary outcome was the detection of a clinically significant arrhythmia. Secondary outcomes included symptom–rhythm correlation and adverse maternal cardiac, obstetric, and fetal outcomes. Out of 124 patients identified, 49 (40%) completed ACM. Two patients had symptomatic clinically significant arrhythmias detected on ACM, including non-sustained ventricular tachycardia that did not alter management (n = 1), and symptomatic supraventricular tachycardia (SVT) resulting in medical therapy (n = 1). Palpitations occurred during monitoring in 35 of the 49 remaining monitored patients; of those, symptoms correlated with non-significant arrhythmias (premature atrial and ventricular contractions) in 11 (31%). No adverse cardiac events occurred in the remaining patients. Obstetric and fetal outcomes did not differ between monitored and unmonitored patients. In this small single center study, ACM in pregnant patients without structural heart disease has a low diagnostic yield. These findings could be used in shared decision-making for pregnant patients being evaluated for palpitations.

Keywords

Pregnancy / Palpitations / Arrhythmia / Ambulatory cardiac monitoring / Supraventricular tachycardia / Cardio-obstetrics / Maternal cardiovascular health

Author Contributions

The authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and for the interpretation discussed. Concept/design: D.K., M.L., W.H.M.V. and L.H.; Data collection: M.G., D.K. and M.L.; Drafting and writing of article: D.K., M.L. and W.H.M.V.; Data analysis/interpretation: D.K., M.L. and W.H.M.V.

Ethics Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of The Ohio State University (study ID 2023H0313; Approval 12/19/23).

Informed Consent Statement

The Ohio State University Biomedical Institutional Review Board approved this study with waivered consent (study ID 2023H0313; Approval 12/19/23).

Data Availability Statement

The retrospective data used to support the findings of this study are restricted by the institutional review board in order to protect patient privacy. Data are available from the corresponding author for researchers who meet the criteria for access to confidential data.

Funding

This research received no external funding.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

[1] American College of Obstetricians and Gynecologists’ Presidential Task Force on Pregnancy and Heart Disease and Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 212: Pregnancy and Heart Disease. Obstet. Gynecol. 2019, 133, e320-e356. DOI: 10.1097/AOG.0000000000003243

[2] Adamson DL, Nelson—Piercy C . Managing palpitations and arrhythmias during pregnancy. Postgrad. Med. J. 2008, 84, 66-72. DOI: 10.1136/hrt.2006.098822

[3] Shotan A, Ostrzega E, Mehra A, Johnson JV, Elkayam U . Incidence of arrhythmias in normal pregnancy and relation to palpitations, dizziness, and syncope. Am. J. Cardiol. 1997, 79, 1061-1064. DOI: 10.1016/s0002—9149(97)00047—7

[4] Bekiaridou A, Coleman KM, Sharma N, George D, Liu Y, Gianos E, et al. Clinical Significance of Supraventricular Tachycardia During Pregnancy in Healthy Women. JACC Clin. Electrophysiol. 2024, 10, 1304-1312. DOI: 10.1016/j.jacep.2024.03.014

[5] Vaidya VR, Arora S, Patel N, Badheka AO, Patel N, Agnihotri K, et al. Burden of Arrhythmia in Pregnancy. Circulation 2017, 135, 619-621. DOI: 10.1161/CIRCULATIONAHA.116.026681

[6] Roldan P, McGrath L, Patel K, Brookfield K, Pare E, Khan A . Utility of continuous electrocardiographic monitoring in pregnant women with cardiovascular disease. Int. J. Cardiol. Congenit. Heart Dis. 2022, 7, 100305. DOI: 10.1016/j.ijcchd.2021.100305

[7] Rodriguez CP, Economy KE, Duarte VE, Mehta N, Duncan ME, Chandler S, et al. Mobile Cardiac Telemetry Use to Predict Adverse Pregnancy Outcomes in Patients with Congenital Heart Disease. JACC Adv. 2023, 2, 100593. DOI: 10.1016/j.jacadv.2023.100593

[8] Benjamin EM, Klugman RA, Luckmann R, Fairchild DG, Abookire SA . Impact of cardiac telemetry on patient safety and cost. Am. J. Manag. Care 2013, 19, e225-32. Available online: https://europepmc.org/article/med/23844751 (accessed on 15 July 2024).

[9] Lang RM, Badano LP, Mor—Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J. Am. Soc. Echocardiogr. 2015, 28, 1-39.e14. DOI: 10.1016/j.echo.2014.10.003

[10] Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography: Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J. Am. Soc. Echocardiogr. 2010, 23, 685-713; quiz 786—788. DOI: 10.1016/j.echo.2010.05.010

[11] Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 183: Postpartum Hemorrhage. Obstet. Gynecol. 2017, 130, e168-e186. DOI: 10.1097/AOG.0000000000002351

[12] Billing for Interruption of Pregnancy: Early Pregnancy Loss. Available online: https://www.acog.org/practice—management/coding/coding—library/billing—for—interruption—of—early—pregnancy—loss (accessed on 25 January 2026).

[13] Preterm Labor and Birth. Available online: https://www.acog.org/womens—health/faqs/preterm—labor—and—birth (accessed on 25 January 2026).

[14] Management of Stillbirth. Available online: https://www.acog.org/clinical/clinical—guidance/obstetric—care—consensus/articles/2020/03/management—of—stillbirth (accessed on 25 January 2026).

[15] Pathirana J, Muñoz FM, Abbing—Karahagopian V, Bhat N, Harris T, Kapoor A, et al. Neonatal death: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2016, 34, 6027-6037. DOI: 10.1016/j.vaccine.2016.03.040

[16] Sanghavi M, Rutherford JD . Cardiovascular Physiology of Pregnancy. Circulation 2014, 130, 1003-1008. DOI: 10.1161/CIRCULATIONAHA.114.009029

[17] Joglar JA, Kapa S, Saarel EV, Dubin AM, Gorenek B, Hameed AB, et al. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm 2023, 20, e175-e264. DOI: 10.1016/j.hrthm.2023.05.017

[18] Shih—Huang L, Shih—Ann C, Tsu—Juey W, Chern—En C, Chen—Chuen C, Ching—Tai T, et al. Effects of pregnancy on first onset and symptoms of paroxysmal supraventricular tachycardia. Am. J. Cardiol. 1995, 76, 675-678. DOI: 10.1016/S0002—9149(99)80195—7