Real pregnancy heart team work: insights from a single-center experience

Abstract

Arrhythmias are increasingly being detected in woman during pregnancy; however, there remains a limited understanding of optimal management strategies and their impact on gestation outcomes.

Purpose: to evaluate pregnancy outcomes of different management strategies for arrhythmias in pregnant women.

Methods: a total of 90 consecutive pregnant women diagnosed with arrhythmia (mean age 27.3±4.3 years, mean gestation age 23.6 ±4.1 weeks) were included. The primary endpoint was term delivery. Pregnancy outcomes were compared across management strategies determined by the multidisciplinary Pregnancy heart team: dynamic observation (group 1, n=15), antiarrhythmic therapy (group 2, n=31) and catheter ablation (group 3, n=44) within 12 month postpartum follow-up.

Results: maternal cardiovascular risk class I (mWHO 2.0) was identified in 36 women (40%) with premature contraction; class II in 46 pregnant (51.1%) with supraventricular tachycardia and class III in 8 cases (8.9%) with ventricular tachycardia, which was rare during gestation. Forty women (44.4%) with prie-exiting arrhythmias had a CARPEG II score of 3, indicating an increased risk of adverse events. Catheter ablation was performed without fluoroscopy in drug refractory and severe arrhythmia cases using CARTO (21 cases; 47.7%) or Ensite Precision systems (23 cases; 52.3%). During pregnancy, uterine contractile activity and placental abruption were observed only in Group 3 (2 cases, 4.5%, p=0.464). Impaired uterine blood flow and preeclampsia occurred across all groups (6 [40%] vs. 4 [12.9] % vs. 6 [13.6%], p=0.152; and 1 [6.7%] vs. 1 [3.2%] vs. 2 [4.5%], p=0.691, respectively). Term delivery occurred in 98.9% of pregnancies, while one woman in Group 3 delivered preterm at 35 weeks (1.1%; p=1.0). Vaginal delivery was predominant across all groups (13 [86.7%] vs. 24 [77.4%] vs. 37 [84%], p=0.575). Fetal birth weight and 5 minute Apgar score were within normal ranges across groups (3140.7±321.2 vs. 3278,2±291,3 vs. 3312,3±209,8 grams, p=0.691; and 8,6±1,1 vs. 8,5±1,2 vs. 8,6±1,2, p=0.721, respectively). No cases of maternal or fetal mortality were observed. During follow-up, no arrhythmia recurrences or adverse maternal cardiac events were recorded. .

Conclusions: despite the presence of higher maternal cardiovascular risk ( mWHO 2.0) and elevated CARPEG II score, pregnancy course and outcomes were favorable across all management strategies. The multidisciplinary Pregnancy heart team approach ensured safe and effective management of arrhythmias during pregnancy.