Successful Obstetric Management of Arrhythmogenic Right Ventricular Cardiomyopathy

Cozzolino, Mauro; Perelli, Federica; Corioni, Serena; Carpinella, Gerardo; Mecacci, Federico

doi:10.1159/000364870

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…None of the prophylactically admitted women ultimately required any intensive measures. This finding is encouraging as it suggests that women with known underlying pathologies are already referred at booking, prior to the onset of complications, and that the risk for major problems in this group is low [6]. The latter is likely the result of pre-emptive measures.…”

Section: Discussionmentioning

confidence: 84%

Obstetric Admissions to the Intensive Care Unit in a Tertiary Hospital

Greve

Mieghem²,

Berghe³

et al. 2016

Gynecol Obstet Invest

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Aims: A better understanding of the characteristics of obstetric patients admitted to an intensive care unit (ICU) could guide where the focus of obstetric training and awareness should be directed at to reduce further maternal mortality and morbidity. Methods: We retrospectively assessed the charts of all women admitted during pregnancy or postpartum to a tertiary ICU over a 12-year period. We retrieved whether women were followed locally or referred from another hospital and whether the ICU admission was prophylactic or therapeutic. Results: There were 190 admissions in 183 women. One-hundred and four admissions were in referred women and 86 in women cared for locally. Seventy-eight admissions (41.1%) were for direct obstetric causes (primarily postpartum hemorrhage (n = 14), hypertensive disorders of pregnancy (n = 12) and peripartum cardiomyopathy (n = 10)). Indirect obstetric admissions (n = 89; 46.8%) were primarily for cardiopathies (n = 35) and pulmonary diseases (n = 18). Among non-obstetric admissions, trauma (n = 6; 26.1%) and neurologic tumors (n = 6; 26.1%) were the most common. Conclusion: Pre-existing and acquired cardiopathies are the main reason for admission to an ICU in a developed country and have surpassed hypertensive disorders and hemorrhage. This should become a focus of obstetric care provider training.

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Section: Discussionmentioning

confidence: 84%

Obstetric Admissions to the Intensive Care Unit in a Tertiary Hospital

Greve

Mieghem²,

Berghe³

et al. 2016

Gynecol Obstet Invest

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“…In contrast, two primigravidae had full-term uncomplicated pregnancies while maintained on β blockers. 11 12 Finally, Iriyama et al 13 and Anouar et al 14 each report an uneventful pregnancy with caesarean delivery in an established patient. The results of our study confirm and significantly extend these findings as we assessed cardiac and obstetric outcomes of sixfold more pregnancies than the largest prior report.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy course and outcomes in women with arrhythmogenic right ventricular cardiomyopathy

Hodes

Tichnell

Riele

et al. 2015

Heart

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ObjectivesTo characterise pregnancy course and outcomes in women with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C).MethodsFrom a combined Johns Hopkins/Dutch ARVD/C registry, we identified 26 women affected with ARVD/C (by 2010 Task Force Criteria) during 39 singleton pregnancies >13 weeks (1–4 per woman). Cardiac symptoms, treatment and episodes of sustained ventricular arrhythmias (VAs) and heart failure (HF) ≥ Class C were characterised. Obstetric outcomes were ascertained. Incidence of VA and HF were compared with rates in the non-pregnant state. Long-term disease course was compared with 117 childbearing-aged female patients with ARVD/C who had not experienced pregnancy with ARVD/C.ResultsTreatment during pregnancy (n=39) included β blockers (n=16), antiarrhythmics (n=6), diuretics (n=3) and implantable cardioverter defibrillators (ICDs) (n=28). In five pregnancies (13%), a single VA occurred, including two ICD-terminated events. Arrhythmias occurred disproportionately in probands without VA history (p=0.045). HF, managed on an outpatient basis, developed in two pregnancies (5%) in women with pre-existing overt biventricular or isolated right ventricular disease. All infants were live-born without major obstetric complications. Caesarean sections (n=11, 28%) had obstetric indications, except one (HF). β Blocker therapy was associated with lower birth weight (3.1±0.48 kg vs 3.7±0.57 kg; p=0.002). During follow-up children remained healthy (median 3.4 years), and mothers were without cardiac mortality or transplant. Neither VA nor HF incidence was significantly increased during pregnancy. ARVD/C course (mean 6.5±5.6 years) did not differ based on pregnancy history.ConclusionsWhile most pregnancies in patients with ARVD/C were tolerated well, 13% were complicated by VA and 5% by HF.

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“…Only case reports [ 1 , 3 , 15 , 22 , 23 , 30 , 33 , 34 , 54 , 61 ] and small series [ 5 , 7 , 9 , 36 ] with a total of 30 pregnancies in 30 women with AC had been reported prior to the first larger case studies and registry reports on pregnancy in AC that were recently published ([ 13 , 27 , 31 , 48 , 69 ]; Tables 1 and 2 ). All reported pregnancies in AC were singleton.…”

Section: Outcomes Of Pregnancy In Women With Acmentioning

confidence: 99%

Pregnancy in arrhythmogenic cardiomyopathy

Wichter

Milberg²,

Wichter³

et al. 2021

Herzschr Elektrophys

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Arrhythmogenic cardiomyopathy (AC) is a rare heart muscle disease with a genetic background and autosomal dominant mode of transmission. The clinical manifestation is characterized by ventricular arrhythmias (VA), heart failure (HF) and the risk of sudden cardiac death (SCD). Pregnancy in young female patients with AC represents a challenging condition for the life and family planning of young affected women. In addition to genetic mechanisms that influence the complex pathophysiology of AC, experimental and clinical data have confirmed the pathogenetic role of strenuous exercise and competitive sports in the early onset and rapid progression of AC symptoms and complications. Pregnancy and exercise share a number of physiological aspects of adaptation. In AC, both result in ventricular volume overload and myocardial stretch. Therefore, pregnancy has been postulated as a potential risk factor for HF, VA, SCD, and pregnancy-related obstetric complications in patients with AC. However, the available evidence on pregnancy in AC does not confirm this hypothesis. In most women with AC, pregnancies are well tolerated, uneventful, and follow a benign course. Pregnancy-related symptoms (VA, syncope, HF) and mortality, as well as obstetric complications, are uncommon in AC patients and range in the order of background populations and cohorts with AC and no pregnancy. The number of completed pregnancies is not associated with an acceleration of AC pathology or an increased risk of VA or HF during pregnancy and follow-up. Accordingly, there is no medical indication to advise against pregnancy in patients with AC. Preconditions include stability of rhythm and hemodynamics at baseline, as well as clinical follow-ups and the availability of multidisciplinary expert consultation during pregnancy and postpartum. Genetic counseling is recommended prior to pregnancy for all couples and their families affected by AC.

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Successful Obstetric Management of Arrhythmogenic Right Ventricular Cardiomyopathy

Cited by 6 publications

References 24 publications

Obstetric Admissions to the Intensive Care Unit in a Tertiary Hospital

Obstetric Admissions to the Intensive Care Unit in a Tertiary Hospital

Pregnancy course and outcomes in women with arrhythmogenic right ventricular cardiomyopathy

Pregnancy in arrhythmogenic cardiomyopathy

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