Ventricular tachyarrhythmia during pregnancy in women with heart disease: Data from the ROPAC, a registry from the European Society of Cardiology

Ertekin, Ebru; Hagen, Iris M. van; Salam, Amar M; Ruys, Titia P.E.; Johnson, Mark R.; Popelová, Jana; Parsonage, William; Ashour, Zeinab; Shotan, Avraham; Oliver, José M.; Veldtman, Gruschen; Hall, Roger; Roos‐Hesselink, Jolien W.

doi:10.1016/j.ijcard.2016.06.061

Cited by 49 publications

(21 citation statements)

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“…Life-threatening VT and VF are very rare during pregnancy or after delivery, but are associated with elevated odds for mortality (OR 40.89, 95% CI 26.08–64.1; P < 0.0001) and increased frequencies of maternal and foetal complications. 2 , 9 Arrhythmia has been reported as a complication of mitral valve prolapse during pregnancy, 10 but as far as we know the relation between MAD and occurrence of arrhythmia during pregnancy has not yet been explored. Perhaps, the so-called ‘mitral valve prolapse syndrome’, which is mentioned in the older literature as being associated with sudden death, was in fact MAD, only not recognized as such.…”

Section: Discussionmentioning

confidence: 99%

Repetitive out of hospital cardiac arrests following pregnancy: a case report of an unfortunate presentation of mitral annular disjunction

Berendoncks

McGhie

Heidbüchel

et al. 2020

European Heart Journal - Case Reports

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Background Mitral annular disjunction (MAD) is an under-recognized cause of arrhythmic sudden cardiac death, especially in young women. The relation between MAD and the occurrence of arrhythmia during pregnancy has not yet been explored. We would like to stress the importance of careful echocardiographic examination and the vulnerable peripartum period. Case summary A 29-year-old woman survived an out of hospital cardiac arrest 4 months after delivery of her first child. The diagnosis was not clear and an implantable cardioverter-defibrillator (ICD) as secondary prevention was implanted. Her second pregnancy and delivery were uneventful. The 12-lead electrocardiogram demonstrated sinus rhythm with right bundle branch block, ventricular extra systoles (premature ventricular contractions), and a right superior axis, i.e. origin in the inferolateral basal left ventricle. Transthoracic 2D echocardiography showed myxomatous mitral valve disease with moderate mitral valve insufficiency with normal left and right heart dimensions and function. However, 4 weeks after delivery she experienced a sudden syncope at home. Implantable cardioverter-defibrillator reading revealed primary ventricular fibrillation, induced by a ventricular premature beat (VPB), terminated with a successful ICD shock. A frame-by-frame echocardiographic analysis of the mitral valve using biplane echocardiographic analysis allowed diagnosis of MAD with detachment of the root of the annulus from the posterolateral ventricular myocardium during systole. Conclusion Mitral annular disjunction is an under-recognized cause of arrhythmic sudden cardiac death. Biplane echocardiographic analysis of the mitral annulus can identify MAD and as such may help for risk stratification and sudden cardiac death prevention. Careful follow-up is necessary especially during pregnancy and the postpartum period.

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Section: Discussionmentioning

confidence: 99%

Repetitive out of hospital cardiac arrests following pregnancy: a case report of an unfortunate presentation of mitral annular disjunction

Berendoncks

McGhie

Heidbüchel

et al. 2020

European Heart Journal - Case Reports

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“…Ventricular arrhythmias (VAs) are much less common in pregnancy than supraventricular arrhythmias and occur most commonly in women with known heart disease at a frequency of approximately 1% [ 25 ]. VAs in women with heart disease occur most commonly late in pregnancy, usually in the third trimester with symptoms of heart failure [ 60 ]. Management, as stated earlier, should be as for the non-pregnant woman, with medications (amiodarone avoided) and defibrillator [implanted cardioverter defibrillator (ICD)] therapy as needed or emergency cardioversion.…”

Section: Pregnancy and Pre-deliverymentioning

confidence: 99%

Heart Disease and Pregnancy

Ashrafi

Curtis

2017

Cardiol Ther

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Cardiac disease remains a major cause of morbidity and mortality in pregnant and post-partum women, although progress has been made, with specialist joint obstetric–cardiology clinics providing an integrated, safe and personalised service to these women. As a result, fewer non-specialist cardiologists are managing women in pregnancy with cardiovascular disease. The aim of this review is to provide a brief overview of current knowledge and practice in the field, with an emphasis on the major physiological changes which occur during pregnancy, focussing on progress through the trimesters, clinical assessment in pregnancy, management of delivery (concentrating on managed vaginal delivery), drug treatment, key conditions and risk assessment. The latter factor is particularly important in terms of being able to identify high-risk women earlier and to counsel them appropriately. Pregnant women with cardiovascular conditions can, with appropriate knowledge and counselling, be managed safely in specialist multidisciplinary services, but there is a need for cardiologists to understand the key changes and risks involved in pregnancy, delivery and the post-partum period.

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“…However, data from a large multicentre study (2966 pregnancies, of which 56% of women had congenital heart disease, 32% valvular heart disease, and 7% cardiomyopathy) showed that pregnant women with heart disease are more likely to encounter episodes of arrhythmia (overall rate 2%). This typically includes a non-sustained tachycardia or frequent ventricular ectopic beats in the late second or third trimester 8. In a separate study from the same cohort (1321 women), 13% of women experienced heart failure, most commonly at the end of the second trimester when plasma volume expansion reaches its peak, or in the peripartum period (typically the period immediately before delivery and up to 48 hours after) 9.…”

Section: What Are the Risks?mentioning

confidence: 99%

Pregnancy in women with congenital heart disease

Cauldwell

Santos

Steer

et al. 2018

BMJ

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Ventricular tachyarrhythmia during pregnancy in women with heart disease: Data from the ROPAC, a registry from the European Society of Cardiology

Abstract: VTA occurred in 1.4% of pregnant women with cardiovascular disease, mainly in the third trimester, and was associated with heart failure during pregnancy. NYHA class before pregnancy was predictive. VTA during pregnancy had clear impact on fetal outcome.

Cited by 49 publications

References 26 publications

Repetitive out of hospital cardiac arrests following pregnancy: a case report of an unfortunate presentation of mitral annular disjunction

Repetitive out of hospital cardiac arrests following pregnancy: a case report of an unfortunate presentation of mitral annular disjunction

Heart Disease and Pregnancy

Pregnancy in women with congenital heart disease

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