First Trimester to Postpartum: a Trimester-Based Analysis of Tachyarrhythmia incidence and Its Association With Maternal Heart Failure Exacerbation

Document Type

Conference Proceeding

Publication Date

4-2026

Publication Title

Heart Rhythm

Abstract

Background: Hemodynamic changes during pregnancy increase the risk of cardiac tachyarrhythmias. Although the overall incidence of tachyarrhythmias in pregnancy has been described, trimester-specific patterns and their impact on maternal outcomes remain limited. Objective: We assessed trimester-specific tachyarrhythmia incidence and related maternal heart failure risk. Methods: Using the TriNetX network, we identified pregnancies with newly diagnosed tachyarrhythmias and stratified them by trimester (1st, 2nd, 3rd, and postpartum [3 months after delivery]). Individuals with a prior history of tachyarrhythmias were excluded. We calculated trimester-specific incidence rates per 100,000 pregnancies for overall tachyarrhythmias and major subtypes, and evaluated the 1- year risk of heart failure (HF) hospitalization. Propensity score matching was used to balance baseline medical and obstetric comorbidities. Results: A total of 9,287,675 pregnancies met inclusion criteria (1st trimester: 19.1%; 2nd: 21.5%; 3rd: 26.6%; postpartum: 32.7%). Supraventricular tachycardia (SVT) was the most common subtype, followed by atrial fibrillation (AF) and ventricular arrhythmias (VA). Overall tachyarrhythmia incidence peaked in the 3rd trimester (300 per 100,000), followed by the 2nd trimester (190), postpartum (177), and the 1st trimester (94). Similar trimester-specific peaks and nadirs were observed across subtypes, though AF and VA showed higher incidence postpartum than in the 2nd trimester. Compared with patients without tachyarrhythmias, those with arrhythmias had higher odds of HF hospitalization. The highest odds occurred with tachyarrhythmias diagnosed in the 1st trimester, with a decreasing trend through the 2nd and 3rd trimesters and postpartum. Subtypes demonstrated similar directional trends in HF risk across gestation. Conclusion: Tachyarrhythmia incidence increased as pregnancy progressed, peaking in the third trimester, with subtype patterns showing similar gestational shifts. Despite this rise in incidence, the highest risk of heart failure hospitalization occurred when tachyarrhythmias were diagnosed in the first trimester, with risk decreasing steadily across later trimesters and postpartum.

Volume

23

Issue

4 Suppl

First Page

S363

Comments

Heart Rhythm Society Annual Meeting, April 23-26, 2026, Chicago, IL

Last Page

S364

DOI

10.1016/j.hrthm.2026.03.442

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