Abstract 4367082: Bridging to Delivery and Respecting Maternal Choice : Wearable Cardioverter Defibrillator Management of Sustained Ventricular Tachycardia in Pregnancy

Abstract

Background: Ventricular arrhythmias during pregnancy present complex management challenges requiring careful balance between maternal safety and fetal well-being. While outflow tract ventricular tachycardia (OTVT) is generally considered benign in non-pregnant patients, pregnancy-related hemodynamic changes can increase arrhythmic burden. Limited data exist regarding optimal management strategies for sustained ventricular tachycardia in pregnancy, particularly when patients prefer outpatient management. Case Presentation: We report a 39-year-old G4P3 female at 29 weeks gestation with chronic palpitations who underwent ambulatory cardiac rhythm monitoring with a Zio patch due to worsening symptoms. Following detection of sustained ventricular tachycardia, the patient was evaluated in the emergency department with continuous telemetry monitoring, echocardiography, and multidisciplinary consultation. Ambulatory monitoring revealed sustained monomorphic ventricular tachycardia episodes lasting up to 12 minutes with heart rates up to 200 bpm, consistent with right ventricular outflow tract origin. The patient experienced lightheadedness but denied syncope or hemodynamic compromise. During hospitalization, telemetry showed sinus tachycardia (90-120 bpm) with frequent premature ventricular contractions but no sustained VT episodes. Beta-blocker therapy was initiated with good tolerance. Given documented sustained VT episodes, symptoms, and patient preference against prolonged hospitalization, a WCD was prescribed for continuous protection until delivery. The patient was successfully discharged home with close outpatient follow-up. Discussion: Wearable cardioverter defibrillator therapy represents a viable management strategy for sustained ventricular tachycardia in pregnancy when patients decline inpatient monitoring. This approach provides continuous arrhythmia protection while respecting patient autonomy and avoiding prolonged hospitalization. The WCD served as an effective bridge to delivery, allowing safe outpatient management with planned post-partum evaluation. This case supports WCD therapy consideration in selected pregnant patients with sustained ventricular arrhythmias appropriate for outpatient management.