Table 1.

Atrial fibrillation recommendations during pregnancy: 2023 Guidelines summary. AF: atrial fibrillation; DCCV: direct current cardioversion; IV: intravenous

AF RECOMMENDATIONS DURING PREGNANCY: 2023 GUIDELINES SUMMARY
Rhythm Control: DCCV is safe in pregnancy and should be performed similar to a nonpregnant patient. Fetal monitoring is used during DCCV. In the absence of structural heart disease, pharmacological cardioversion with agents with a history of safe use (IV procainamide) may be used during pregnancy. For maintenance of normal sinus rhythm, agents with a history of safe use (flecainide and sotalol) are reasonable during pregnancy.
Rate Control: Rate control can be achieved using agents with a history of safe use (propranolol, metoprolol, digoxin) as first-line agents.
Anticoagulation: Shared Decision Making is important Current tools that predict stroke risk in AF are not validated in pregnancy. Most data is extrapolated from managing valvular heart disease patients. First Trimester: Warfarin ≤ 5 mg or low molecular weight heparin or unfractionated heparin Second Trimester: Warfarin or low molecular weight heparin Third Trimester: Warfarin until a week before delivery Switch to unfractionated heparin (or low molecular weight heparin) and stop 4-6 hours pre-delivery