[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-444235-105":59,"doc-detail-444235-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","management-of-ablation-refractory-atrial-fibrillation-during-pregnancy","Management of Ablation-Refractory Atrial Fibrillation During Pregnancy","","A case report describes management of ablation-refractory atrial fibrillation during pregnancy in a structurally normal heart. A 35-year-old woman at 19 weeks of gestation presented with recurrent paroxysmal AF after prior pregnancy-related drug-refractory episodes and a prior catheter ablation. Multiple rate- and rhythm-control therapies failed, and medication escalation led to syncope and persistent palpitations requiring emergency evaluation. The case highlights hemodynamic and fetal-safety limits of pharmacologic titration and the feasibility of invasive rhythm control before delivery.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/management-of-ablation-refractory-atrial-fibrillation-during-pregnancy/444235/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/management-of-ablation-refractory-atrial-fibrillation-during-pregnancy/444235.png","ImageObject",300,407,{"name":92,"@type":93},"Cipher","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-05","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":24},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is early recognition and treatment of atrial fibrillation important during pregnancy?","Question",{"text":112,"@type":113},"Atrial fibrillation can cause hemodynamic changes that may adversely affect both mother and fetus, potentially leading to poor outcomes.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What therapies failed in the reported patient during prior pregnancy episodes?",{"text":117,"@type":113},"Despite treatment with metoprolol and pill-in-pocket fecainide, the patient had poorly controlled AF and failed trials of digoxin and verapamil; labetalol was also associated with hypotension.",{"name":119,"@type":110,"acceptedAnswer":120},"How did medication adjustment affect the patient when AF recurred in the current pregnancy?",{"text":121,"@type":113},"She was unresponsive to a scheduled regimen, leading to increased beta-blocker dosing; this was followed by syncope and persistent palpitations prompting emergency department presentation.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},444235,1790726698,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},687208528416,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Wiley  \nCase Reports in Medicine  \nVolume 2026, Article ID 1768682, 5 pages [https://doi.org/10.1155/carm/1768682](https://doi.org/10.1155/carm/1768682)  \nCase Report  \nManagement of Ablation-Refractory Atrial Fibrillation During Pregnancy  \nFaris Abu Za’nouneh , Kevin Benavente , Jadon Neuendorf, Blake Kadomoto, and Christina Chong  \nDepartment of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu 96813, Hawaii, USA  \nCorrespondence should be addressed to Faris Abu Za’nouneh; [faz@hawaii.edu](faz@hawaii.edu)  \nReceived 26 April 2025; Revised 4 December 2025; Accepted 17 December 2025  \nAcademic Editor: Amr A. Arafat  \nCopyright © 2026 Faris Abu Za’nouneh et al. Case Reports in Medicine published by John Wiley & Sons Ltd. Tis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \nDevelopment of new atrial fbrillation (AF) is uncommon in pregnancy with an incidence of 0.03% . Te occurrence of drugrefractory AF during pregnancy in individuals with structurally normal hearts is even rarer, and there are no reports ofablationrefractory AF during pregnancy in the literature. Early recognition and treatment of AF are crucial, as it causes hemodynamic changes that can adversely impact both the mother and fetus, potentially resulting in poor outcomes. We report a case of a 35-year-old woman at 19 weeks of gestation who presented with recurrent paroxysmal AF. Two years earlier, during her previous pregnancy, she was hospitalized for AF, where she experienced labetalol-related hypotension and failed therapy with verapamil and digoxin. She was then managed with fecainide pill-in-pocket therapy until delivery. Eighteen months before this pregnancy, she underwent catheter ablation and remained stable until this current pregnancy, when she experienced 2 episodes of AF. Tese episodes were unresponsive to her scheduled regimen, prompting an increase in her beta-blocker dose. However, the patient developed syncope and persistent palpitations prompting her presentation to the emergency department (ED) .  \nKeywords: ablation; antiarrhythmics; atrial fbrillation; pregnancy; recurrence  \n1. Introduction  \nPregnancy increases physiologic and metabolic demands, upregulates sympathetic tone and catecholamine release, signifcantly expands intravascular volume, and leads toa cascade of hormonal changes that induce cardiac stress. Arrhythmias are the most common cardiovascular complication in pregnant patients with or without preexisting heart disease [1] . While the overall incidence of developing AF during pregnancy is rare, its prevalence is rapidly growing, with an 111% increase in cases from 2000 to 2012 [2] . Historically, supraventricular tachycardias (SVTs) were the most common arrhythmias of pregnancy, but AF has surpassed SVT in prevalence, emerging as the leading arrhythmia identifed. Contributors to the increased frequency of AF could be due to increases in  \nmaternal age and in risk factors such as hypertension, diabetes mellitus, and obesity in pregnancy [2, 3] . Additionally, women with a pre-existing history of AF have a recurrence rate of up to 39.2% during pregnancy [4] . While 75% of AF cases during pregnancy will convert to normal sinus rhythm with medications alone, up to 12.3% will remain recurrent, permanent, or require direct current cardioversion [5] . Our case is of particular interest given that it highlights refractory, recurrent atrial fbrillation (AF) during pregnancy in a structurally normal heart. It underscores the challenges of pharmacologic management in pregnancy where titration is limited by maternal hemodynamic tolerance and fetal safety consideration, while highlighting the feasibility of invasive rhythm control strategies prior to delivery. We herein report a case ofa 35-year-old pregnant woman presenting  \n2 Case Reports in Medicine  \nwith recurre","cbCaiqulc4h7yieW","https://ap.wps.com/l/cbCaiqulc4h7yieW","pdf",2050986,"English","# Introduction\n# Case Report","[{\"question\":\"Why is early recognition and treatment of atrial fibrillation important during pregnancy?\",\"answer\":\"Atrial fibrillation can cause hemodynamic changes that may adversely affect both mother and fetus, potentially leading to poor outcomes.\"},{\"question\":\"What therapies failed in the reported patient during prior pregnancy episodes?\",\"answer\":\"Despite treatment with metoprolol and pill-in-pocket fecainide, the patient had poorly controlled AF and failed trials of digoxin and verapamil; labetalol was also associated with hypotension.\"},{\"question\":\"How did medication adjustment affect the patient when AF recurred in the current pregnancy?\",\"answer\":\"She was unresponsive to a scheduled regimen, leading to increased beta-blocker dosing; this was followed by syncope and persistent palpitations prompting emergency department presentation.\"}]","Management of Ablation-Refractory Atrial Fibrillation During Pregnancy | PDF",1790707289,13]