Atrial Fibrillation in Pregnancy: an Anaesthetic Predicament

Developing countries with higher prevalence of RHD encounter cases of AF in pregnancy. Szekely et al reported new onset of AF in 8% of pregnant patients with RHD.1 Dilatation of LA, elevated LA pressure and myocardial stretch due to mitral valve disease results in slow conduction velocities, increased dispersion of refractoriness and automaticity leading to AF. Occurrence is common in third trimester due to Increased HR, cardiac output, heart size, plasma volume, wall tension and decreased SVR. AF intensifies hemodynamic changes and predisposes to heart failure.