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Martin G, Narvaez-Guerra O, Aurigemma G, Kovell L. Peripartum ventricular tachycardia and PVC-induced cardiomyopathy: delivering optimal care when it's time to deliver. BMJ Case Rep 2024; 17:e259075. [PMID: 38839415 DOI: 10.1136/bcr-2023-259075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Ventricular tachycardia (VT) is a rare but potentially fatal complication in pregnancy. We present a case of a pregnant woman with cardiomyopathy due to frequent premature ventricular complexes (PVCs) and VT originating from the left ventricular outflow tract. After presenting late in the third trimester, the decision was made to deliver the fetus after 4 days of medication titration due to continued sustained episodes of VT. After delivery, the patient continued to have frequent PVCs and VT several months after discharge, and she ultimately underwent a PVC ablation with dramatic reduction in PVC burden and improvement in cardiomyopathy. Multidisciplinary planning with a pregnancy heart team led to appropriate contingency planning and a successful delivery. This case highlights how multidisciplinary management is best practice in pregnancy complicated by VT and the need for better diagnostic guidelines for PVC-induced cardiomyopathy in the setting of pregnancy.
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Affiliation(s)
- Gabrielle Martin
- Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Offdan Narvaez-Guerra
- Cardiovascular Medicine, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Gerard Aurigemma
- Cardiovascular Medicine, UMass Memorial Medical Center, Worcester, Massachusetts, USA
| | - Lara Kovell
- Cardiovascular Medicine, UMass Memorial Medical Center, Worcester, Massachusetts, USA
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Olic JJ, Stöllberger C, Schukro C, Odening KE, Reuschel E, Fischer M, Veltmann C, Duncker D, Baessler A. Usage of the wearable cardioverter-defibrillator during pregnancy. IJC HEART & VASCULATURE 2022; 41:101066. [PMID: 35676917 PMCID: PMC9168609 DOI: 10.1016/j.ijcha.2022.101066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/15/2022] [Accepted: 05/25/2022] [Indexed: 11/25/2022]
Abstract
Background Pregnancy can trigger or aggravate the risk for life-threating arrhythmias in cardiac diseases. Pregnancy is associated with reluctance for implantable cardioverter-defibrillators (ICD) due to concerns about radiation. Thus, the wearable cardioverter-defibrillator (WCD) might be an option during pregnancy. Aim of the study was to collect experiences about the use of WCD in pregnancy. Methods and results This study retrospectively included eight women who received a WCD during pregnancy. They suffered from ventricular tachycardia (VT) without known cardiac disease (n = 3), Brugada syndrome (n = 1), hypertrophic cardiomyopathy (n = 1), dilated cardiomyopathy (n = 1), non-compaction (n = 1), and survived sudden cardiac arrest during a preceding pregnancy (n = 1). WCD usage was started between 13 and 28 weeks of gestation. WCD wearing period ranged from 3 days to 30.9 weeks, WCD wearing time ranged from 13.0 to 23.7 h per day. Two women (25%) abandoned WCD already during pregnancy. Neither appropriate nor inappropriate WCD shocks were recorded. Antiarrhythmic management included beta-blockers (n = 5) and flecainide (n = 2). After delivery, ICD were implanted (n = 4), refused (n = 2) and estimated not necessary after successful catheter ablation (n = 2). Conclusion Uneventful pregnancy is possible in women at risk for sudden cardiac death by interdisciplinary monitoring and diligent pharmacotherapy protected by the WCD. Since no WCD shocks were recorded, the effectiveness of WCD during pregnancy is still unclear. However, arrhythmia detection by WCD was very good despite the changed anatomy in pregnancy. Nevertheless, further studies are necessary to assess effectiveness of WCD in pregnant women. Furthermore, efforts should be made to increase the wearing adherence of WCD during pregnancy.
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Affiliation(s)
- J.-Jacqueline Olic
- Department of Cardiology, University Hospital of Regensburg, Regensburg, Germany
| | | | - Christoph Schukro
- Department for Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Katja E. Odening
- Translational Cardiology, Department of Cardiology and Institute of Physiology, University Hospital Bern, University of Bern, Switzerland
| | - Edith Reuschel
- University Department of Obstetrics and Gynecology At The Hospital St. Hedwig of The Order of St. John, University of Regensburg, 93049 Regensburg, Germany
| | - Marcus Fischer
- Department of Cardiology, University Hospital of Regensburg, Regensburg, Germany
| | - Christian Veltmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Andrea Baessler
- Department of Cardiology, University Hospital of Regensburg, Regensburg, Germany
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Eckert H, El-Battrawy I, Veith M, Roterberg G, Kowitz J, Lang S, Zhou X, Akin I, Mügge A, Aweimer A. Pooled Analysis of Complications with Transvenous ICD Compared to Subcutaneous ICD in Patients with Catecholaminergic Polymorphic Ventricular Arrhythmia. J Pers Med 2022; 12:jpm12040536. [PMID: 35455651 PMCID: PMC9029805 DOI: 10.3390/jpm12040536] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is associated with arrhythmic events which may lead to sudden cardiac death (SCD). A leading therapy for CPVT besides medical treatment with beta-blockers is the use of an implantable cardioverter-defibrillator (ICD). For this paper we compared data from a pooled analysis to get further evidence about the complications of transvenous and subcutaneous ICDs. Methods: We gathered data from a search of PubMed, Web of Science, Cochrane Library and Cinahl. For our analysis, we chose 30 studies with a total number of 784 patients. We compared the data regarding complications caused by different ICD device types. Results: During a mean follow up of 38.9 months for the patients with ICD implantation (n = 337), data showed a complication rate of 101 (30%). A total of 330 (98%) of them received a transvenous-ICD (T-ICD) and 7 (2%) a subcutaneous-ICD (S-ICD). A total of 97 (29.4%) of the T-ICD patients and 4 (57.1%) of the S-ICD patients had at least one complication. Of the 234 complications that occurred in T-ICD patients 152 (65%) were inappropriate shocks due to supraventricular arrhythmias, T/R-wave oversensing or electrode defect, 26 (11.1%) lead fracture/failure, 1 (0.4%) electrode defect, 46 were (19.7%) events of electrical storms, 1 (0.4%) thromboembolic event, 2 (0.8%) cases of endocarditis and 6 (2.6%) infections of the ICD-pocket. Ten (100%) of the complications for the four patients with the S-ICD were an event of an inappropriate shock due to supraventricular arrhythmias, T/R-wave oversensing or electrode defect. Conclusion: Subcutaneous ICDs (S-ICD) show a certain advantage over T-ICDs regarding lead-related complications. Nevertheless, they still show problems with inappropriate shocks and other ICD related complications. Therefore, a case-by-case decision is advised, but the continuous improvement of S-ICD might make it an overall advantageous therapy option in the future.
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Affiliation(s)
- Henrik Eckert
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (H.E.); (M.V.); (G.R.); (J.K.); (S.L.); (X.Z.); (I.A.)
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (H.E.); (M.V.); (G.R.); (J.K.); (S.L.); (X.Z.); (I.A.)
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
- Bergmannsheil Bochum, Medical Clinic II, Department of Cardiology and Angiology, Ruhr University, 44789 Bochum, Germany; (A.M.); (A.A.)
- Correspondence: ; Tel.: +49-621-383-1447
| | - Michael Veith
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (H.E.); (M.V.); (G.R.); (J.K.); (S.L.); (X.Z.); (I.A.)
| | - Gretje Roterberg
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (H.E.); (M.V.); (G.R.); (J.K.); (S.L.); (X.Z.); (I.A.)
| | - Jacqueline Kowitz
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (H.E.); (M.V.); (G.R.); (J.K.); (S.L.); (X.Z.); (I.A.)
| | - Siegfried Lang
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (H.E.); (M.V.); (G.R.); (J.K.); (S.L.); (X.Z.); (I.A.)
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
| | - Xiaobo Zhou
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (H.E.); (M.V.); (G.R.); (J.K.); (S.L.); (X.Z.); (I.A.)
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, 68167 Mannheim, Germany; (H.E.); (M.V.); (G.R.); (J.K.); (S.L.); (X.Z.); (I.A.)
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, 68167 Mannheim, Germany
| | - Andreas Mügge
- Bergmannsheil Bochum, Medical Clinic II, Department of Cardiology and Angiology, Ruhr University, 44789 Bochum, Germany; (A.M.); (A.A.)
| | - Assem Aweimer
- Bergmannsheil Bochum, Medical Clinic II, Department of Cardiology and Angiology, Ruhr University, 44789 Bochum, Germany; (A.M.); (A.A.)
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Approach to inherited arrhythmias in pregnancy. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Wong GR, Ang M, Jayarajan J, Walker F, Lambiase PD. Pregnancy in patients with implantable cardiac defibrillators. Herzschrittmacherther Elektrophysiol 2021; 32:214-220. [PMID: 33970332 DOI: 10.1007/s00399-021-00750-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/15/2021] [Indexed: 02/05/2023]
Abstract
The number of patients of reproductive age with inherited and congenital heart disease receiving implantable cardiac defibrillators (ICD) is steadily increasing. Safely and effectively coordinating pregnancy in this high-risk cohort is important to optimise maternal-foetal outcomes. As members of the multidisciplinary team caring for pregnant patients with indications for ICD, cardiologists and electrophysiologists should be aware of the considerations and nuances involved in managing these patients. This article reviews the pathophysiology of arrhythmias, ICD implantation considerations, novel minimal fluoroscopy techniques and subcutaneous ICD. In addition, antenatal and device management during pregnancy and delivery are discussed.
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Affiliation(s)
- Geoffrey R Wong
- Department of Electrophysiology, St Bartholomews Hospital NHS Trust & Institute of Cardiovascular Science UCL, London, UK
| | - Megan Ang
- Department of Obstetric Imaging, Mercy Hospital for Women, Melbourne, Australia
| | - Jasveer Jayarajan
- Department of Obstetric Imaging, Mercy Hospital for Women, Melbourne, Australia
| | - Fiona Walker
- Department of Grown-Up Congenital Heart Disease, St Bartholomews Hospital, London, UK
| | - Pier D Lambiase
- Department of Electrophysiology, St Bartholomews Hospital NHS Trust & Institute of Cardiovascular Science UCL, London, UK.
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Roston TM, Grewal J, Krahn AD. Pregnancy in catecholaminergic polymorphic ventricular tachycardia: therapeutic optimization and multidisciplinary care are key to success. Herzschrittmacherther Elektrophysiol 2021; 32:199-206. [PMID: 33881608 DOI: 10.1007/s00399-021-00755-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
Women of child-bearing age comprise a large proportion of the patients followed by inherited arrhythmia clinics. Despite being a rare and dangerous diagnosis, cardiac and obstetric care providers should know that catecholaminergic polymorphic ventricular tachycardia (CPVT) is not a contraindication to pregnancy. In fact, pregnancy was not associated with an increased risk of CPVT-associated arrhythmias in a recent large cohort study, and most guideline-based anti-arrhythmic drug treatments are life-saving and carry a low risk of teratogenesis. In principle, the potential for CPVT destabilization may be more likely to occur after anti-arrhythmic drugs are decreased or stopped during pregnancy, when an implantable cardioverter defibrillator (ICD) shock exacerbates catecholamine release, or if adrenaline surges are triggered by labor and delivery. Therefore, all pregnant women should be followed by a cardio-obstetrics team with extensive knowledge of CPVT diagnosis, as well as arrhythmia risk stratification fand management. This multidisciplinary care should begin preconception and involve counseling on preimplantation genetic testing, choosing safe and effective anti-arrhythmic drugs, stopping contraindicated medications, optimal programming of ICDs, and planning for the brief hyper-adrenergic period of labor and delivery. The latest data on pregnancy in CPVT is reviewed here and the optimal care for this rare and complex patient population outlined.
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Affiliation(s)
- Thomas M Roston
- Centre for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Jasmine Grewal
- Centre for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Andrew D Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, The University of British Columbia, Vancouver, Canada. .,, 211-1033 Davie Street, V6E 1M7, Vancouver, BC, Canada.
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Topf A, Bacher N, Kopp K, Mirna M, Larbig R, Brandt MC, Kraus J, Hoppe UC, Motloch LJ, Lichtenauer M. Management of Implantable Cardioverter-Defibrillators during Pregnancy-A Systematic Review. J Clin Med 2021; 10:jcm10081675. [PMID: 33919684 PMCID: PMC8069958 DOI: 10.3390/jcm10081675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022] Open
Abstract
Background: With the advent of implantable cardioverter-defibrillator (ICD) technology in recent decades, patients with inherited or congenital cardiomyopathy have a greater chance of survival into adulthood. Women with ICDs in this group are now more likely to reach reproductive age. However, pregnancy represents a challenge for clinicians, as no guidelines for the treatment of pregnant women with an ICD are currently available. Methods: To analyze this issue, we performed a systematic screening of the literature using the keywords: pregnancy with ICD, lead fracture in pregnancy, lead thrombi in pregnancy, ventricular tachycardia in pregnancy, inappropriate shocks in pregnancy, ICD discharge in pregnancy and ICD shock in pregnancy. Of 1101 publications found, 27 publications were eligible for further analysis (four retrospective trials and 23 case reports). Results: According to physiological changes in pregnancy, resulting in an increase in heart rate and cardiac output, a vulnerability for malignant arrhythmias and device-related complications in ICD carriers might be suspected. While the literature is limited on this issue, maternal complications including arrhythmia burden with following ICD therapies, thromboembolic events and lead complications as well as inappropriate shock therapy have been reported. According to the limited available studies, associated risk seems not to be more frequent than in the general population and depends on the underlying cardiac pathology. Furthermore, worsening of heart failure and related cardiovascular disease have been reported with associated risk of preterm delivery. These observations are exaggerated by restricted applications of diagnostics and treatment due to the risk of fetal harm in this population. Conclusions: Due to limited data on management of ICDs during pregnancy, further scientific investigations are required. Consequently, careful risk assessment with individual risk evaluation and close follow ups with interdisciplinary treatment are recommended in pregnant ICD carriers.
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Affiliation(s)
- Albert Topf
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
- Correspondence:
| | - Nina Bacher
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
| | - Kristen Kopp
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
| | - Moritz Mirna
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
| | - Robert Larbig
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, 41063 Mönchengladbach, Germany;
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany
| | - Mathias C. Brandt
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
| | - Johannes Kraus
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
| | - Uta C. Hoppe
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
| | - Lukas J. Motloch
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
| | - Michael Lichtenauer
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
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Schumer A, Contag S. Catecholaminergic polymorphic ventricular tachycardia in pregnancy: a case report. J Med Case Rep 2020; 14:238. [PMID: 33292493 PMCID: PMC7724802 DOI: 10.1186/s13256-020-02569-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/28/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a genetic disorder that can cause fatal tachyarrhythmias brought on by physical or emotional stress. There is little reported in the literature regarding management of CPVT in pregnancy much less during labor. Case presentation A gravida 2, para 1 presented to our high-risk clinic at 15 weeks gestation with known CPVT. The Caucasian female patient had been diagnosed after experiencing a cardiac arrest following a motor vehicle accident and found to have a pathogenic cardiac ryanodine receptor mutation. An implantable cardioverter defibrillator was placed at that time. Her pregnancy was uncomplicated, and she was medically managed with metoprolol, flecainide, and verapamil. Her labor course and successful vaginal delivery were uncomplicated and involved a multidisciplinary team comprising specialists in electrophysiology, maternal fetal medicine, anesthesiology, general obstetrics, lactation, and neonatology. Conclusions CPVT is likely underdiagnosed and, given that cardiovascular disease is a leading cause of death in pregnancy, it is important to bring further awareness to the diagnosis and management of this inherited arrhythmia syndrome in pregnancy.
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Affiliation(s)
- Amy Schumer
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Stephen Contag
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA
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Jimenez E, Cortez D, McGill M, Ambrose M. Peripartum management of a patient with catecholaminergic polymorphic ventricular tachycardia. Ann Noninvasive Electrocardiol 2020; 26:e12796. [PMID: 32978983 PMCID: PMC7935095 DOI: 10.1111/anec.12796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 11/30/2022] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a potentially lethal cardiac channelopathy characterized by episodes of ventricular tachycardia (VT) during exercise or in stressful situations. As the peripartum period creates a stressful environment, we describe our approach of this rare condition in a very common situation, child birth.
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Affiliation(s)
- Erick Jimenez
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel Cortez
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mark McGill
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Matthew Ambrose
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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Abstract
Pregnancy is a period of increased cardiovascular risk in a woman's life. In the setting of an inherited arrhythmia syndrome (IAS), cardiologists and obstetricians may be unfamiliar with cardiovascular optimization and risk stratification in pregnancy. Historically, there were little data addressing the safety of pregnancy in these rare disorders. Recent advances suggest that no type of IAS represents an absolute contraindication to pregnancy. However, it is imperative that obstetric and cardiovascular clinicians understand the major forms of IAS and how they affect the risks and course of pregnancy. This includes any disease-specific proarrhythmic triggers unique to pregnancy, such as the postpartum period in long QT syndrome (especially type 2), which poses the greatest risk of arrhythmias, and the adrenergic nature of labor and delivery, which is relevant to catecholaminergic polymorphic ventricular tachycardia. Fortunately, several effective antiarrhythmic options exist that pose little fetal risk. IAS-specific optimization of implantable cardioverter-defibrillator algorithms, drug therapy, and a maternal cardiac plan addressing the antepartum, labor, and delivery and postpartum periods reduces the risk. Where evidence does not exist, there are plausible mechanistic considerations to guide clinicians. To achieve optimal outcomes, early involvement of an expert pregnancy heart team comprising obstetrics, genetics, cardiology, and anesthesiology team members and a shared decision-making approach to IAS issues in pregnancy are needed.
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Cheung CC, Lieve KV, Roston TM, van der Ree MH, Deyell MW, Andrade JG, Laksman ZW, Nannenberg EA, Tadros R, Pang B, Rutberg J, Green MS, Conacher S, Seifer CM, Roberts JD, Steinberg C, Sanatani S, Wilde AA, Krahn AD. Pregnancy in Catecholaminergic Polymorphic Ventricular Tachycardia. JACC Clin Electrophysiol 2018; 5:387-394. [PMID: 30898243 DOI: 10.1016/j.jacep.2018.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This investigation was a retrospective study of catecholaminergic polymorphic ventricular tachycardia (CPVT) patients in Canada and the Netherlands to compare pregnancy, postpartum, and nonpregnant event rates. BACKGROUND CPVT is characterized by life-threatening arrhythmias during exertion or emotional stress. The arrhythmic risk in CPVT patients during pregnancy is unknown. METHODS Baseline demographics, genetics, treatment, and pregnancy complications were reviewed. Event rate calculations assumed a 40-week pregnancy and 24-week postpartum period. RESULTS Ninety-six CPVT patients had 228 pregnancies (median 2 pregnancies per patient; range: 1 to 10; total: 175.4 pregnant patient-years). The median age of CPVT diagnosis was 40.7 years (range: 12 to 84 years), with a median follow-up of 2.9 years (range: 0 to 20 years; total 448.1 patient-years). Most patients had pregnancies before CPVT diagnosis (82%). Pregnancy and postpartum cardiac events included syncope (5%) and an aborted cardiac arrest (1%), which occurred in patients who were not taking beta-blockers. Other complications included miscarriages (13%) and intrauterine growth restriction (1 case). There were 6 cardiac events (6%) during the nonpregnant period. The pregnancy and postpartum event rates were 1.71 and 2.85 events per 100 patient-years, respectively, and the combined event rate during the pregnancy and postpartum period was 2.14 events per 100 patient-years. These rates were not different from the nonpregnant event rate (1.46 events per 100 patient-years). CONCLUSIONS The combined pregnancy and postpartum arrhythmic risk in CPVT patients was not elevated compared with the nonpregnant period. Most patients had pregnancies before diagnosis, and all patients with events were not taking beta-blockers at the time of the event.
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Affiliation(s)
- Christopher C Cheung
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Krystien V Lieve
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
| | - Thomas M Roston
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martijn H van der Ree
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
| | - Marc W Deyell
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason G Andrade
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zachary W Laksman
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eline A Nannenberg
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands; Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Rafik Tadros
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
| | - Benjamin Pang
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Julie Rutberg
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Martin S Green
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Susan Conacher
- Division of Cardiology, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Colette M Seifer
- Division of Cardiology, University of Manitoba, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Jason D Roberts
- Division of Cardiology, University of Manitoba, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Shubhayan Sanatani
- Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Arthur A Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
| | - Andrew D Krahn
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
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Ahmed A, Phillips JR. Teenage pregnancy with catecholaminergic polymorphic ventricular tachycardia and documented ICD discharges. Clin Case Rep 2016; 4:361-5. [PMID: 27099728 PMCID: PMC4831384 DOI: 10.1002/ccr3.366] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/07/2015] [Accepted: 07/25/2015] [Indexed: 11/17/2022] Open
Abstract
We report the first case of pregnancy in a pediatric patient with catecholiminergic polymorphic ventricular tachycardia (CPVT). Pregnant adolescents with CPVT are at high risk for NSVT and malignant VT during pregnancy, despite antiarrhythmic medication. They may receive multiple implantable cardioverter defibrillator (ICD) therapies. Such patients require close monitoring with special care during the first trimester.
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Affiliation(s)
- Aziez Ahmed
- Department of Pediatrics West Virginia University-Charleston Area Medical Center 830 Pennsylvania Avenue Suite 102 Charleston West Virginia 25302
| | - John R Phillips
- Department of Pediatric Cardiology Ruby Memorial Hospital West Virginia University-Morgantown P.O. Box 9214 Morgantown West Virginia 26506
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