Pregnancy-associated idiopathic ventricular arrhythmia: Serial electrocardiographic evolution during pregnancy and postpartum.

Pregnancy can trigger or exacerbate ventricular arrhythmias even in structurally normal hearts. A 41-year-old woman at 22 weeks' gestation developed symptomatic monomorphic premature ventricular contractions (PVCs) and frequent nonsustained ventricular tachycardia (NSVT), with 11% PVC burden and 313 NSVT episodes. Metoprolol reduced arrhythmic burden but not symptoms. Sotalol, introduced with serial QT monitoring, was followed by complete symptomatic and Holter suppression. One month postpartum, asymptomatic ventricular arrhythmia recurred off therapy, then resolved spontaneously by three months. Serial monitoring illustrates marked pregnancy-related variability and the potential dissociation between symptoms and arrhythmic burden.