Evaluation of palpitations in pregnancy using an ambulatory event monitor

Palpitations are a common complaint in pregnancy, yet the clinical significance and diagnostic utility of ambulatory cardiac monitoring in this population remain unclear.

This single-center retrospective study included 111 pregnant patients referred to an obstetric cardiology clinic for palpitations. Demographic and clinical characteristics, echocardiographic findings, and ambulatory event monitor data were analyzed. The primary outcome was arrhythmia detection, with secondary outcomes including medical management changes and maternal and fetal outcomes.

Of the 111 patients, 61 (55%) underwent ambulatory cardiac monitoring, with arrhythmias detected in 28 (46%) of those monitored. Symptom correlation with rhythm abnormalities was documented in 13 (46%) patients with arrhythmia. Beta-blockers were initiated or continued in 7 (25%) patients with detected arrhythmia, but this was not statistically different from patients without arrhythmia. There was no significant association between arrhythmia detection and patient age, gravidity, gestational age, or prior history of arrhythmia or valvular disease. Speckle tracking echocardiography was performed in 25 patients (28.7%), and global longitudinal strain (GLS) did not significantly correlate with arrhythmia detection (-12.6 ± 10 vs. -15.6 ± 9; Kendall's tau = 0.08, p = 0.728). Pregnancy and fetal outcomes did not differ significantly based on arrhythmia detection.

Symptom-guided ambulatory monitoring in pregnancy identified clinically relevant arrhythmias in a subset of patients, including those without prior cardiac history. While this occasionally influenced management, the therapeutic yield was modest. These findings support a selective monitoring approach and emphasize the need for larger studies to identify patients most likely to benefit.