Atrial Fibrillation or Flutter During Pregnancy in Patients With Structural Heart Disease

Salam, Amar M; Ertekin, Ebru; Hagen, Iris M. van; Suwaidi, Jassim Al; Ruys, Titia P.E.; Johnson, Mark R.; Gumbienė, Lina; Frogoudaki, Alexandra; Sorour, Khaled; Iserin, Laurence; Ladouceur, Magalie; Oppen, A. C. C. van; Hall, Roger; Roos‐Hesselink, Jolien W.

doi:10.1016/j.jacep.2015.04.013

Cited by 51 publications

(35 citation statements)

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“…The rate of AF in our population is lower than what was reported from ROPAC (Registry on Pregnancy and Cardiac Disease). 19 In the ROPAC registry, 17 of 1321 pregnant women (1.3%) developed AF during pregnancy. Because structural heart disease is one of the most powerful predictors for AF, 20 it is perhaps not surprising that prevalence of AF is higher in the ROPAC population, where all women have structural heart disease, whereas the majority of women in our population have structurally normal hearts.…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation and Atrial Flutter in Pregnant Women—A Population‐Based Study

Lee

Chen

Zhang

et al. 2016

JAHA

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BackgroundThe goal of this study was to determine the prevalence of atrial fibrillation and atrial flutter (AF) in pregnant women and to examine the impact of AF on maternal and fetal outcomes.Methods and ResultsBetween January 1, 2003 and December 31, 2013, there were 264 730 qualifying pregnancies (in 210 356 women) in the Kaiser Permanente Southern California hospitals, among whom AF was noted in 157 pregnancies (129 women; 61.3 per 100 000 women, or 59.3 per 100 000 pregnancies). Prevalence of AF (per 100 000 women) in white, black, Asian, and Hispanic women was 111.6, 101.7, 45.0, and 34.3, respectively. Older age was associated with higher odds of having AF. Compared to women <25 years of age, the odds ratio (OR) of AF was 4.1 in women age 30 to 34 years, 4.9 in women age 35 to 39 years, and 5.2 in women age ≥40. Odds of AF episodes were higher during the third trimester compared to the first trimester (OR, 3.2; 95% CI: 1.5–7.7). Among AF patients, adverse maternal cardiac events were rare—2 women developed heart failure and there were no strokes or systemic embolic events and no maternal death. There were 156 live births (99.4% of all pregnancies). Compared to women without AF, fetal birth weights were similar, but rate for neonates’ admission to the neonatal intensive care unit was higher (10.8% vs 5.1%; P=0.003).Conclusions AF is rare in pregnant women. Certain factors such as increased maternal age and white race increase the odds of having AF. Major maternal and fetal complications are infrequent, albeit a source of concern.

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Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation and Atrial Flutter in Pregnant Women—A Population‐Based Study

Lee

Chen

Zhang

et al. 2016

JAHA

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“…Wiąże się ono ze wzrostem częstości występowania powikłań u matki i płodu [911,912]. Lepsze leczenie wrodzonych wad serca prawdopodobnie spowoduje w przyszłości zwiększenie częstości występowania AF podczas ciąży [913].…”

Section: Ciążaunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,331

4,193

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“…The incidence of AF/IART in patients with structural heart disease was reported at 1.3% by the Registry on Pregnancy and Cardiac Disease with the majority of arrhythmias occurring during second trimester[102]. The frequency of arrhythmia during pregnancy is higher than this in other studies and certain ACHD subgroups.…”

Section: Atrial Arrhythmias During Pregnancy In Achd Patientsmentioning

confidence: 99%

Atrial tachyarrhythmia in adult congenital heart disease

Karbassi¹,

Nair²,

Harris³

et al. 2017

WJC

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The adult congenital heart disease (ACHD) population continues to grow and most cardiologists, emergency room physicians and family doctors will intermittently come into contact with these patients. Oftentimes this may be in the setting of a presentation with atrial tachyarrhythmia; one of the commonest late complications of ACHD and problem with potentially serious implications. Providing appropriate initial care and ongoing management of atrial tachyarrhythmia in ACHD patients requires a degree of specialist knowledge and an awareness of certain key issues. In ACHD, atrial tachyarrhythmia is usually related to the abnormal anatomy of the underlying heart defect and often occurs as a result of surgical scar or a consequence of residual hemodynamic or electrical disturbances. Arrhythmias significantly increase mortality and morbidity in ACHD and are the most frequent reason for ACHD hospitalization. Intra-atrial reentrant tachycardia and atrial fibrillation are the most prevalent type of arrhythmia in this patient group. In hemodynamically unstable patients, urgent cardioversion is required. Acute management of the stable patient includes anticoagulation, rate control, and electrical or pharmacological cardioversion. In ACHD, rhythm control is the preferred management strategy and can often be achieved. However, in the long-term, medication side-effects can prove problematic. Electrophysiology studies and catheter ablation are important treatments modalities and in certain cases, surgical or percutaneous treatment of the underlying cardiac defect has a role. ACHD patients, especially those with complex CHD, are at increased risk of thromboembolic events and anticoagulation is usually required. Female ACHD patients of child bearing age may wish to pursue pregnancies. The risk of atrial arrhythmias is increased during pregnancy and management of atrial tachyarrhythmia during pregnancy needs specific consideration.

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Atrial Fibrillation or Flutter During Pregnancy in Patients With Structural Heart Disease

Abstract: AF/AFL occurs in 1.3% of pregnant patients with structural heart disease with a peak at the end of the second trimester. AF/AFL during pregnancy in cardiac patients is associated with unfavorable maternal outcome and also has an impact on fetal birth weight.

Cited by 51 publications

References 25 publications

Atrial Fibrillation and Atrial Flutter in Pregnant Women—A Population‐Based Study

Atrial Fibrillation and Atrial Flutter in Pregnant Women—A Population‐Based Study

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Atrial tachyarrhythmia in adult congenital heart disease

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