BackgroundThe mechanistic basis of the proposed relationship between maternal cardiac output and neonatal complications in pregnant women with heart disease has not been well elucidated.Methods and ResultsPregnant women with cardiac disease and healthy pregnant women (controls) were prospectively followed with maternal echocardiography and obstetrical ultrasound scans at baseline, third trimester, and postpartum. Fetal/neonatal complications (death, small‐for‐gestational‐age or low birthweight, prematurity, respiratory distress syndrome, or intraventricular hemorrhage) comprised the primary study outcome. One hundred and twenty‐seven women with cardiac disease and 45 healthy controls were enrolled. Neonatal events occurred in 28 pregnancies and were more frequent in the heart disease group as compared with controls (n=26/127 or 21% versus n=2/45 or 4%; P=0.01). Multiple complications in an infant were counted as a single outcome event. Neonatal complications in the heart disease group were small‐for‐gestational‐age/low birthweight (n=18), prematurity (n=14), and intraventricular hemorrhage/respiratory distress syndrome (n=5). Preexisting obstetric risk factors (P=0.003), maternal cardiac output decline from baseline to third trimester (P=0.017), and third trimester umbilical artery Doppler abnormalities (P<0.001) independently predicted neonatal complications and were incorporated into a novel risk index in which 0, 1, and >1 predictor corresponded to expected complication rates of 5%, 30%, and 76%, respectively.ConclusionsDecline in maternal cardiac output during pregnancy and abnormal umbilical artery Doppler flows independently predict neonatal complications. These findings will enhance the identification of higher risk pregnancies that would benefit from close antenatal surveillance.

RES, J.C.J., ET AL.: First Results of the Canadian and European Single Lead DDD Studies. A Report of Two Multicenter Studies on Vena Cava Atrial Stimulation (VECATS). The first results of a new, single lead DDD pacing system consisting of two bipolar combinations of floating atrial ring electrodes, with the prox imal ring at the vena cava superior junction, and which can be used separately for atrial sensing and pac ing (VECATS) are reported. Uncomplicated implantation of the pacing system was performed in 78 pa tients with VDD indications. Pacing and sensing parameters were measured at implantation, before discharge (days 1-3), at 1 and 3 months in various positions and during activity. Atrial pacing threshold (AT) and diaphragmatic stimulation threshold (DT) were 3.3 ± 1.1 V and 7.2 ± 2.2 at implant, and 4.3 ± 0.5 and 7.9 ±1.1 Vat 3 months, respectively, in the European group. In the Canadian group AT increased and DT decreased during follow-up, leaving a safety margin of 1 V. Reliable intraoperative atrial pacing was possible in 93% of patients. Failures were caused by no capture (3%) or AT > DT (4%). At 3 months, 54% of the atria were consistently paced. Atrial pacing failures were due to no atrial capture (8%), and AT > DT (38%o). We conclude that atrial pacing was safe and initially possible in the majority of patients with the VECATS pacing system, though diaphragmatic stimulation became more prevalent over time, due to an increase in AT threshold and a decrease in DT. (PACE 2000; 23:[Pt. II]:1804-1808) vena cava atrial stimulation (VECATS), atrial pacing, floating electrodes, diaphragmatic stimulation, single lead DDD pacing

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