Atrial fibrillation with rapid ventricular response as a maternal presentation of mirror syndrome: a case report

Mirror syndrome is the phenomenon of fetal hydrops causing maternal edema and weight gain. Here, we report a case of arrhythmia as the primary maternal symptom. A 36-year-old woman, G2P1001, at 34.5 weeks of gestation presented with new-onset fetal hydrops combined with maternal weight gain and edema. She developed atrial fibrillation with rapid ventricular response; cardiac workup was unremarkable. Rate control was achieved with diltiazem. She underwent delivery and reverted to normal sinus rhythm on post-operative day 1. Volume overload causes atrial wall stress and neurohormonal changes that may trigger atrial fibrillation. Optimization with rate control facilitated good maternal and fetal outcomes in this case. •Mirror syndrome is a phenomenon in which fetal hydrops is “mirrored” in the mother, causing edema and weight gain.•We report a case of maternal arrhythmia as the primary maternal symptom of mirror syndrome.•In cases of maternal atrial fibrillation, optimization with rate control can facilitate good obstetric outcomes.