Life-Sustaining Rhythms: Pregnancy in a Patient with a Pacemaker

Abstract

Cardiac pacemakers are essential electronic devices used to manage arrhythmias and conduction issues. The first documented case involving a pregnant woman with a pacemaker in 1962 underscores the evolving intersection of cardiac pacing and obstetrics. Primary indications for pacemaker implantation in reproductive-aged women include sinus node dysfunction and AV block, with various types chosen based on individual cardiac abnormalities. Pregnancy with a pacemaker generally proceeds well under multidisciplinary care, focusing on symptom monitoring and adjustments to pacemaker settings if required. Anaesthesia and surgical planning consider pacemaker status and electrolyte balance besides precautions during surgery to preserve pacemaker function.

A 23-year-old woman, G3P2L2NND1, who had previously undergone two lower segment caesarean sections (LSCS), presented at four months of pregnancy with a permanent pacemaker implanted two years earlier. Her first LSCS for twins was complicated by peripartum cardiomyopathy, managed in the ICU postpartum. Subsequently developing complete heart block, she underwent successful DDDR pacemaker insertion. Her subsequent pregnancies were managed similarly, with an emergency LSCS at 36 weeks during the second pregnancy and an elective LSCS with tubal ligation at 37 weeks during the third. Effective management of pregnancy with a pacemaker requires vigilant monitoring and collaborative care among obstetricians, cardiologists, and anaesthesiologists to optimize outcomes for both mother and foetus.