Pyotr G Platonov1, Anna I Castrini2,3, Anneli Svensson4,5, Morten K Christiansen6,7, Thomas Gilljam8, Henning Bundgaard9,10, Trine Madsen11, Tiina Heliö12, Alex H Christensen13, Meriam Aneq Åström14,15, Jonas Carlson1, Thor Edvardsen2,3, Henrik K Jensen6,7, Kristina H Haugaa2,3, Jesper H Svendsen9,10. 1. Department of Cardiology, Clinical Sciences, Lund University, 22185 Lund, Sweden. 2. Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 3. Institute for clinical Medicine, University of Oslo, Oslo, Norway. 4. Department of Cardiology, Linköping University, Linköping, Sweden. 5. Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden. 6. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. 7. Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark. 8. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 9. Department of Cardiology, Centre of Cardiac-, Vascular-, Pulmonary- and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark. 10. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. 11. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. 12. Department of Cardiology, Helsinki University Hospital, Helsinki, Finland. 13. Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. 14. Department of Clinical Physiology, Linköping University, Linköping, Sweden. 15. Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Abstract
AIMS: Women with arrhythmogenic right ventricular cardiomyopathy (ARVC) are at relatively lower risk of ventricular arrhythmias (VAs) than men, but the physical burden associated with pregnancy on VA risk remains insufficiently studied. We aimed to assess the risk of VA in relation to pregnancies in women with ARVC. METHODS AND RESULTS: We included 199 females with definite ARVC (n = 121) and mutation-positive family members without ascertained ARVC diagnosis (n = 78), of whom 120 had at least one childbirth. Ventricular arrhythmia-free survival after the latest childbirth was compared between women with one (n = 20), two (n = 67), and three or more (n = 37) childbirths. Cumulative probability of VA for each pregnancy (n = 261) was assessed from conception through 2 years after childbirth and compared between those pregnancies that occurred before (n = 191) or after (n = 19) ARVC diagnosis and in mutation-positive family members (n = 51). The nulliparous women had lower median age at ARVC diagnosis (38 vs. 42 years, P < 0.001) and first VA (22 vs. 41 years, P < 0.001). Ventricular arrhythmia-free survival after the latest childbirth was not related to the number of pregnancies. No pregnancy-related VA was reported among the family members. Women who gave birth after ARVC diagnosis had elevated risk of VA postpartum (hazard ratio 13.74, 95% confidence interval 2.9-63, P = 0.001), though only two events occurred during pregnancies. CONCLUSION: In women with ARVC, pregnancy was uneventful for the overwhelming majority and the number of prior completed pregnancies was not associated with VA risk. Pregnancy-related VA was primarily related to the phenotypical severity rather than pregnancy itself. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Women with arrhythmogenic right ventricular cardiomyopathy (ARVC) are at relatively lower risk of ventricular arrhythmias (VAs) than men, but the physical burden associated with pregnancy on VA risk remains insufficiently studied. We aimed to assess the risk of VA in relation to pregnancies in women with ARVC. METHODS AND RESULTS: We included 199 females with definite ARVC (n = 121) and mutation-positive family members without ascertained ARVC diagnosis (n = 78), of whom 120 had at least one childbirth. Ventricular arrhythmia-free survival after the latest childbirth was compared between women with one (n = 20), two (n = 67), and three or more (n = 37) childbirths. Cumulative probability of VA for each pregnancy (n = 261) was assessed from conception through 2 years after childbirth and compared between those pregnancies that occurred before (n = 191) or after (n = 19) ARVC diagnosis and in mutation-positive family members (n = 51). The nulliparous women had lower median age at ARVC diagnosis (38 vs. 42 years, P < 0.001) and first VA (22 vs. 41 years, P < 0.001). Ventricular arrhythmia-free survival after the latest childbirth was not related to the number of pregnancies. No pregnancy-related VA was reported among the family members. Women who gave birth after ARVC diagnosis had elevated risk of VA postpartum (hazard ratio 13.74, 95% confidence interval 2.9-63, P = 0.001), though only two events occurred during pregnancies. CONCLUSION: In women with ARVC, pregnancy was uneventful for the overwhelming majority and the number of prior completed pregnancies was not associated with VA risk. Pregnancy-related VA was primarily related to the phenotypical severity rather than pregnancy itself. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Anna I Castrini; Eystein Skjølsvik; Mette E Estensen; Vibeke M Almaas; Helge Skulstad; Erik Lyseggen; Thor Edvardsen; Øyvind H Lie; Kermshlise C I Picard; Neal K Lakdawala; Kristina H Haugaa Journal: J Am Heart Assoc Date: 2022-04-18 Impact factor: 6.106