Paroxysmal Supraventricular Tachycardia With Wolff-Parkinson-White (WPW) Syndrome: A Therapeutic Dilemma During Pregnancy

Arrhythmias are among the most common cardiac complications during pregnancy, occurring in women with or without underlying structural heart disease. Early recognition and timely management are crucial to achieving the best possible maternal and fetal outcomes. Supraventricular arrhythmias are particularly frequent during pregnancy. Wolff-Parkinson-White (WPW) syndrome is a rare pre-excitation disorder characterized by the presence of an accessory pathway and can occasionally lead to life-threatening arrhythmias. The exact prevalence of WPW syndrome predisposing to supraventricular tachycardia (SVT) in pregnancy is not known. We present a case of a 28-year-old woman in her second trimester of pregnancy presenting with sudden-onset palpitations. She was hemodynamically stable on presentation, and her electrocardiogram (ECG) recording demonstrated SVT with a heart rate of 226 beats per minute. After a failure of vagal maneuvers, she was successfully treated with intravenous adenosine. Her subsequent ECG was consistent with WPW syndrome with delta waves. This case highlights the complexities in managing a case of SVT in pregnancy with WPW syndrome during its acute phase and follow-up. With pregnancy being a risk factor for an arrhythmogenic state, the presence of an accessory pathway may further increase the risk of fatal arrhythmia. Management should be approached keeping both maternal and fetal outcomes in perspective.