Dataset Information

Pregnancy course and outcomes in women with arrhythmogenic right ventricular cardiomyopathy.

ABSTRACT:

Objectives

To characterise pregnancy course and outcomes in women with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C).

Methods

From 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.

Results

Treatment during pregnancy (n=39) included ? 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). ? 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.

Conclusions

While most pregnancies in patients with ARVD/C were tolerated well, 13% were complicated by VA and 5% by HF.

SUBMITTER: Hodes AR

PROVIDER: S-EPMC4752646 | biostudies-literature | 2016 Feb

REPOSITORIES: biostudies-literature

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Publications

Pregnancy course and outcomes in women with arrhythmogenic right ventricular cardiomyopathy.

Hodes Anke R AR Tichnell Crystal C Te Riele Anneline S J M AS Murray Brittney B Groeneweg Judith A JA Sawant Abhishek C AC Russell Stuart D SD van Spaendonck-Zwarts Karin Y KY van den Berg Maarten P MP Wilde Arthur A AA Tandri Harikrishna H Judge Daniel P DP Hauer Richard N W RN Calkins Hugh H van Tintelen J Peter JP James Cynthia A CA

Heart (British Cardiac Society) 20151230 4

<h4>Objectives</h4>To characterise pregnancy course and outcomes in women with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C).<h4>Methods</h4>From 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 outco ...[more]

PMID: 26719359

Similar Datasets

Project description:Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by ventricular arrhythmias and an increased risk of sudden cardiac death. Although structural abnormalities of the right ventricle predominate, it is well recognized that left ventricular involvement is common, particularly in advanced disease, and that left-dominant forms occur. The pathological characteristic of ARVC is myocyte loss with fibrofatty replacement. Since the first detailed clinical description of the disorder in 1982, significant advances have been made in understanding this disease. Once the diagnosis of ARVC is established, the single most important clinical decision is whether a particular patient's sudden cardiac death risk is sufficient to justify placement of an implantable cardioverter-defibrillator. The importance of this decision reflects the fact that ARVC is a common cause of sudden death in young people and that sudden death may be the first manifestation of the disease. This decision is particularly important because these are often young patients who are expected to live for many years. Although an implantable cardioverter-defibrillator can save lives in individuals with this disease, it is also well recognized that implantable cardioverter-defibrillator therapy is associated with both short- and long-term complications. Decisions about the placement of an implantable cardioverter-defibrillator are based on an estimate of a patient's risk of sudden cardiac death, as well as their preferences and values. The primary purpose of this article is to provide a review of the literature that concerns risk stratification in patients with ARVC and to place this literature in the framework of the 3 authors' considerable lifetime experiences in caring for patients with ARVC. The most important parameters to consider when determining arrhythmic risk include electric instability, including the frequency of premature ventricular contractions and sustained ventricular arrhythmia; proband status; extent of structural disease; cardiac syncope; male sex; the presence of multiple mutations or a mutation in TMEM43; and the patient's willingness to restrict exercise and to eliminate participation in competitive or endurance exercise.

Dataset Information

Pregnancy course and outcomes in women with arrhythmogenic right ventricular cardiomyopathy.

Objectives

Methods

Results

Conclusions

Publications

Pregnancy course and outcomes in women with arrhythmogenic right ventricular cardiomyopathy.

Similar Datasets

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