A challenging case of pregnancy complicated by arrhythmogenic right ventricular cardiomyopathy requiring synchronous cardioversion

<p> The patient, a 37-year-old woman who had previously undergone three uneventful deliveries（gravida 4 para3）, was diagnosed with arrhythmogenic right ventricular cardiomyopathy following her third delivery. At 28 weeks and 2 days into her fourth pregnancy, she sought medical attention at our hospital emergency department due to complaints of palpitations and loss of consciousness. During her visit, she experienced frequent, brief episodes of unconsciousness lasting approximately 7 seconds, and her electrocardiogram indicated nonsustained ventricular tachycardia. As her ventricular tachycardia became persistent and her blood pressure dropped, she was administered intravenous amiodarone. Given her condition, it was decided that transferring her would be challenging. Consequently, an emergency caesarean section was performed under general anesthesia. Immediately after the delivery, which occurred 143 minutes after the onset of sustained ventricular tachycardia, synchronized cardioversion was conducted to restore her sinus rhythm. Post-surgery, she was transferred to a tertiary care facility. In retrospect, it was observed that her blood pressure had already decreased at the time of amiodarone administration, suggesting that synchronous cardioversion should have been considered at that earlier stage. This case underscores the importance of perinatal healthcare professionals being well-versed in the timing of synchronous cardioversion.</p>