title: The unexpected pitter patter: new-onset atrial fibrillation in pregnancy.
abstract: Background. Atrial fibrillation is a relatively uncommon but dangerous complication of pregnancy. Emergency physicians must know how to treat both stable and unstable tachycardias in late pregnancy. In this case, a 40-year-old female with a cerclage due to incompetent cervix and previous preterm deliveries presents in new-onset atrial fibrillation. Case Report. A previously healthy 40-year-old African American G2 P1 female with a 23-week twin gestation complicated by an incompetent cervix requiring a cervical cerclage presented to the emergency department with intermittent palpitations and shortness of breath for the past two months. EMS noted the patient to have a tachydysrhythmia, atrial fibrillation with rapid ventricular response. She was placed on a diltiazem drip, which was titrated to 15 mg/hr without successful rate control. Her heart rate remained in the 130s and the rhythm continued to be atrial fibrillation with RVR. Digoxin was then added as a second agent, and discussions about the potential risks of cardioversion in pregnancy ensued. Fortunately, the patient converted to sinus rhythm before cardioversion became necessary. The digoxin was discontinued; the diltiazem was also discontinued after the patient subsequently developed hypotension. "Why Should Emergency Physicians Be Aware of This?" New-onset atrial fibrillation is rare in pregnancy but can increase the mortality and morbidity of the mother and fetus if not treated promptly.
authors.affiliation: Dell School of Medicine, University of Texas at Austin, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: White
authors.affiliation: Dell School of Medicine, University of Texas at Austin, USA.
authors.forename: Janna
authors.identifier: 0000-0002-4905-0143
authors.initials: J
authors.lastname: Welch
authors.affiliation: Dell School of Medicine, University of Texas at Austin, USA.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Brown