Pregnancy in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy.

Hodes, A. (Anke) (2015) Pregnancy in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy. thesis, Medicine.

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Abstract

Introduction: Earlier detection and successful treatment of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) increases the number of patients considering pregnancy. Methods: In a combined Johns Hopkins/Dutch ARVD/C registry we identified 26 women (5 Dutch; 13 probands) who met ARVD/C 2010 Task Force Criteria during 39 singleton viable pregnancies (1-4 per woman). Cardiac and obstetric outcomes were ascertained in all. Ventricular arrhythmia and heart failure (HF) rates were compared with those in nulliparous women (n=65) and women who finished childbearing before diagnosis (n=115). Results: Pregnancy began at a mean age of 31.3±3.5 years. ARVD/C was diagnosed prior to most pregnancies (n=29; 74%), whereas in 7 ARVD/C (18%) was present beforehand but not yet clinically recognized, and 3 pregnancies (8%) were ongoing at time of diagnosis. Treatment in pregnancies included beta blockers (n=16), sotalol (n=4), flecainide (n=1), digoxin (n=1), diuretics (n=3) and ICDs (n=28). Most pregnancies were uneventful (n=23; 59%); new/worsening symptoms were noted in 9 (23%), including palpitations/PVCs and/or fatigue/dyspnea. A single sustained VT or appropriate ICD intervention occurred in 5 pregnancies (13%), all in women without history of such events and 2 following beta blocker interruption: 3 first-trimester sustained VTs (ARVD/C not yet established), 1 first-trimester ICD discharge and 1 second-trimester anti-tachycardia pacing (ARVD/C established). In contrast, 9 pregnancies in women with VT/ICD-discharge history were without events. AHA Class C HF developed in 2 pregnancies (5%), in women with either biventricular structural disease or tricuspid valve disease pre-pregnancy. They were managed outpatient and are stable 2 and 5 years post-delivery. In 9 other pregnancies with significant structural RV disease no HF developed. All pregnancies resulted in live-born children without major obstetric complications. Of 11 C-sections (28%), only 1 was exclusively ARVD/C-related (HF). At last follow-up all children were healthy (0-23 years); mothers had no cardiac mortality or transplant. Ventricular arrhythmia and heart failure were not significantly more common than in the comparison groups. Conclusion: Although caution is warranted in women with established biventricular or valve disease and when interrupting beta blocker-use, pregnancy and delivery appear to be reasonably safe in ARVD/C, especially when recognized pre-pregnancy. With adequate guidance and treatment a favorable outcome for both mother and child is generally obtained.

Item Type:	Thesis (Thesis)
Supervisor name:	Tintelen, Dr. J.P. van and Boer, Prof. dr. R.A. de
Supervisor name:	James, Cynthia A. ScM and Johns Hopkins University and Division of Cardiology and Baltimore (Maryland, USA)
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:57
Last Modified:	25 Jun 2020 10:57
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1784

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