ABC | Volume 114, Nº5, May 2020

Statement Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease – 2020 Arq Bras Cardiol. 2020; 114(5):849-942 Table 28 – Practice for acute supraventricular tachycardia Recommendation Immediate electrical cardioversion as a first choice for SVT with maternal hemodynamic instability and AF in pregnant women with ventricular pre-excitation syndrome Vagal maneuvers; in the event that they are inefficient, adenosine for acute reversion of PSVT Endovenous beta-blockers (metoprolol, propranolol) for acute reversion of PSVT Endovenous verapamil for acute reversion of PSVT when adenosine and beta-blockers are not effective, or when they are contraindicated Endovenous procainamide for acute reversion of SVT Flecainide or ibutilide for acute reversion of flutter and AF in pregnant women with structurally normal hearts Amiodarone for acute reversion of potentially severe SVT when other therapies are not effective, or when they are contraindicated AF: atrial fibrillation; PSVT: paroxysmal supraventricular tachycardia; SVT: supraventricular tachycardia. Table 29 – Practice for chronic supraventricular tachycardia Recommendation Beta-blockers or verapamil to prevent PSVT in pregnant women without pre-excitation on ECG Beta-blockers for controlling ventricular response in pregnant women with AF or atrial tachycardia Flecainide or propafenone for preventing PSVT in patients with Wolff-Parkinson-White syndrome Flecainide, propafenone, or sotalol syndrome for preventing PSVT, atrial tachycardia, and AF when there is no response to beta-blockers Digoxin or verapamil for controlling heart rate in atrial tachycardia and AF when there is no response to beta-blockers Catheter ablation with the use of electroanatomical mapping systems for SVT that are not well tolerated or refractory to treatment with antiarrhythmic drugs ECG: electrocardiography; AF: atrial fibrillation; PSVT: paroxysmal supraventricular tachycardia; SVT: supraventricular tachycardia. Table 30 – Practice for acute ventricular tachycardia Recommendation Immediate electrical cardioversion as a first choice for pregnant women with sustained VT, with or without hemodynamic instability Beta-blockers, sotalol, flecainide, procainamide, or overdrive ventricular pacing for reversion of hemodynamically stable, idiopathic, monomorphic sustained VT VT: ventricular tachycardia. 6 weeks postpartum. Nonetheless, recent studies have shown an increase in the risk of thromboembolism for up to 180 days postpartum in patients with some obstetric risk factors, including cesarean delivery and twin gestation. 131,334,335 5.2.2. Risk Factors The Table 32 lists preexisting, transitory, and obstetric risk factors associated with thromboembolism during gestation. It has been suggested that the presence of 2 or more of these factors further increases the risk of disease; prior history of thrombosis, however, is the most important individual risk factor. The recurrence of thrombosis during this period increases 3- to 4-fold, accounting for 15% to 25% of all cases of thromboembolism during gestation. 336,337 5.2.3. Thrombophilia Thrombophilia comprises a state of congenital or acquired hypercoagulability. This issue, when isolated, even in the context of pregnancy, does not necessarily result in the occurrence of thromboembolism; 338 the rarity of thromboembolism during pregnancy and the high incidence of hereditary thrombophilias do not justify systematic tracking of this disease. Venous thrombosis is a polygenic disease with incomplete penetration, which makes genetic counseling uncertain. The risk of thromboembolism associated with different thrombophilias and its prevalence in the general population are shown in Table 33. There is limited value to tracking thrombophilias in pregnant women with acute thromboembolism, because it does not modify clinical practice. For this reason, investigation of thrombophilia is recommended during gestation in the following situations, 339 with the following classes of evidence: • Based on clinical risk (class IB); • Family history (first-degree relatives) of thromboembolism without a detectable cause or occurring during hormonal exposure, or a minor risk factor, or still under the age of 50 should be investigated (class IIC); 905