Ebru Ertekin1, Iris M van Hagen1, Amar M Salam2, Titia P E Ruys1, Mark R Johnson3, Jana Popelova4, William A Parsonage5, Zeinab Ashour6, Avraham Shotan7, José M Oliver8, Gruschen R Veldtman9, Roger Hall10, Jolien W Roos-Hesselink11. 1. Erasmus University Medical Center, Rotterdam, The Netherlands. 2. Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. 3. Imperial College School of Medicine, Chelsea and Westminster Hospital, London, United Kingdom. 4. Hospital Na Homolce & Pediatric Heart Center University Hospital Motol, Prague, Czech Republic. 5. Royal Brisbane & Women's Hospital, Herston, Australia. 6. Cairo University, Cairo, Egypt. 7. Hillel Yaffe Medical Center, Hadera, Israel. 8. Adult Congenital Heart Disease Unit, La Paz University Hospital, Madrid, Spain. 9. Adolescent and Adult Congenital Heart Program, Cincinnati Children's Hospital, Cincinnati,United States. 10. Norwich Medical School, University of East Anglia, Norwich, United Kingdom. 11. Erasmus University Medical Center, Rotterdam, The Netherlands; Fellow of the European Society of Cardiology, Sophia Antipolis Cedex, France. Electronic address: j.roos@erasmusmc.nl.
Abstract
OBJECTIVES: To describe the incidence, onset, predictors and outcome of ventricular tachyarrhythmia (VTA) in pregnant women with heart disease. BACKGROUND: VTA during pregnancy will cause maternal morbidity and even mortality and will have impact on fetal outcome. Insufficient data exist on the incidence and outcome of VTA in pregnancy. METHODS AND RESULTS: From January 2007 up to October 2013, 99 hospitals in 39 countries enrolled 2966 pregnancies in women with structural heart disease. Forty-two women (1.4%) developed clinically relevant VTA during pregnancy, which occurred mainly in the third trimester (48%). NYHA class >1 before pregnancy was an independent predictor for VTA. Heart failure during pregnancy was more common in women with VTA than in women without VTA (24% vs. 12%, p=0.03) and maternal mortality was respectively 2.4% and 0.3% (p=0.15). More women with VTA delivered by Cesarean section than women without VTA (68% vs. 47%, p=0.01). Neonatal death, preterm birth (<37weeks), low birthweight (<2500g) and Apgar score <7 occurred more often in women with VTA (4.8% vs. 0.3%, p=0.01; 36% vs. 16%, p=0.001; 33% vs. 15%, p=0.001 and 25% vs. 7.3%, p=0.001, respectively). CONCLUSIONS: 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.
OBJECTIVES: To describe the incidence, onset, predictors and outcome of ventricular tachyarrhythmia (VTA) in pregnant women with heart disease. BACKGROUND: VTA during pregnancy will cause maternal morbidity and even mortality and will have impact on fetal outcome. Insufficient data exist on the incidence and outcome of VTA in pregnancy. METHODS AND RESULTS: From January 2007 up to October 2013, 99 hospitals in 39 countries enrolled 2966 pregnancies in women with structural heart disease. Forty-two women (1.4%) developed clinically relevant VTA during pregnancy, which occurred mainly in the third trimester (48%). NYHA class >1 before pregnancy was an independent predictor for VTA. Heart failure during pregnancy was more common in women with VTA than in women without VTA (24% vs. 12%, p=0.03) and maternal mortality was respectively 2.4% and 0.3% (p=0.15). More women with VTA delivered by Cesarean section than women without VTA (68% vs. 47%, p=0.01). Neonatal death, preterm birth (<37weeks), low birthweight (<2500g) and Apgar score <7 occurred more often in women with VTA (4.8% vs. 0.3%, p=0.01; 36% vs. 16%, p=0.001; 33% vs. 15%, p=0.001 and 25% vs. 7.3%, p=0.001, respectively). CONCLUSIONS: 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.