ECG changes in pregnancy - An observational study

Abstract

Introduction: Arrhythmias in pregnancy may cause concern for the wellbeing of mothers and fetuses. Understanding the physiologic changes and types of arrhythmias that occur during pregnancy can help in identifying cases requiring intervention. This study aimed to determine the prevalence and types of electrocardiography changes and cardiac arrhythmias in normal pregnancy. Materials and Methods: This observational study was conducted at a tertiary care hospital. Four hundred and fifty women aged 20–35 years with singleton pregnancy in early gestation, irrespective of parity, comprised the study group. A baseline ECG of the first trimester was reviewed with repeat ECG at 22–24 weeks and 32 weeks along with 24-h Holter studies during 20–24 weeks. Results: The most common rhythm disturbance was ventricular premature contractions (1.8%), followed by atrial fibrillation (0.7%). A significant association was seen between rhythm disturbances with advancing age and pregnancy-induced hypertension. No difference was observed between P-axis wave and PR interval. QRS axis and duration decreased significantly from the time of enrollment to 22–24 weeks to 32 weeks, whereas QTc interval increased during the course of pregnancy. No ST/T-wave changes were seen in any of the cases at enrollment, whereas at 22–24 and at 32 weeks, new T-wave inversion was observed in 8.2%. Conclusion: ECG changes such as reduction in QRS axis, T-wave inversion in lead III and V1–2, and prolonged QTc were observed in pregnant women. The prevalence of rhythm disturbances was low, with ventricular premature complex being the most common pathology. Minor electrocardiographic changes may be considered normal in pregnancy unless associated with significant symptoms.

Keywords

• arrhythmias
• electrocardiography
• pregnancy