Recommendations for Pregnancy

Referenced studies that support the recommendations are summarized in the Online Data Supplement.

COR	LOE	Recommendations
1	B-NR	1. In pregnant patients with AF, DCCV is safe to the patient and fetus and should be performed in the same manner as in patients who are not pregnant.1
2b	C-LD	2. In pregnant individuals with structurally normal hearts and hemodynamically stable AF, pharmacological cardioversion with agents with history of safe use in pregnancy, such as intravenous procainamide, may be considered.1,2
2a	C-LD	3. In pregnant individuals with AF and without structural heart disease, antiarrhythmic agents with history of safe use in pregnancy (eg, flecainide and sotalol) are reasonable for maintenance of sinus rhythm.1,2
2a	B-NR	4. In pregnant individuals with persistent AF, rate-control agents with a record of safety in pregnancy, such as beta blockers (eg, propranolol or metoprolol) and digoxin, either alone or in combination with beta blockers, are reasonable as first-line agents.1,2
2b	C-LD	5. Pregnant individuals with AF and elevated risk of stroke may be considered for anticoagulation with the recognition that no anticoagulation strategy is completely safe for both the mother and fetus, and an SDM discussion should take place regarding risks to both mother and fetus (Table 28).3