IDIOPATHIC CARDIAC ARRHYTHMIAS IN PREGNANCY: CLINICAL AND HOLTER MONITORING FEATURES, PREGNANCY OUTCOMES AND A CLINICAL SIGNIFICANCE SCORE

Resume. Background. Idiopathic cardiac arrhythmias are common in pregnancy, but current guidelines provide no quantitative criteria for deciding how intensively these women should be monitored. Aim. To describe the clinical, laboratory and Holter monitoring features of idiopathic arrhythmias in pregnancy, compare pregnancy outcomes with healthy pregnant women, and develop a clinical significance score with a management algorithm. Methods. A single-centre cross-sectional comparative study was conducted at Samarkand State Medical University in 2024-2026. The main group included 50 pregnant women with idiopathic arrhythmias, the control group 30 women with uncomplicated pregnancy. All women underwent clinical assessment, laboratory tests, ECG and echocardiography; women in the main group also underwent 24-hour Holter monitoring. Pregnancy and delivery outcomes were recorded. Results. The groups were comparable by age, parity and gestational age. Supraventricular premature beats (38.0%), sinus tachycardia (30.0%) and ventricular premature beats (26.0%) predominated. Symptoms were reported by 90.0% of the main group versus 36.7% of controls (p<0.001). Arrhythmic burden on Holter monitoring depended on the arrhythmia type (p<0.001) but not on the trimester (p=0.098-0.482). Complication and caesarean section rates did not differ between groups, but birth weight was lower in the main group (3263±42 vs 3454±47 g; p=0.003). A 0-7 point clinical significance score was proposed; applied to the main group, it classified 24.0% of women as low, 62.0% as intermediate and 14.0% as high clinical significance. Conclusion. In pregnant women with idiopathic arrhythmias, the severity of arrhythmia is determined by its type and quantitative burden rather than by gestational age. The proposed score and algorithm allow the intensity of follow-up to be individualised; their prognostic value requires prospective validation. Keywords: pregnancy, cardiac arrhythmias, premature beats, Holter monitoring, risk stratification, birth weight.