Pregnancy course and outcomes in women with arrhythmogenic right ventricular cardiomyopathy

Anke R. Hodes, Crystal Tichnell, Anneline S.J.M. Te Riele, Brittney Murray, Judith A. Groeneweg, Abhishek C. Sawant, Stuart D. Russell, Karin Y. Van Spaendonck-Zwarts, Maarten P. Van Den Berg, Arthur A. Wilde, Harikrishna Tandri, Daniel P. Judge, Richard N.W. Hauer, Hugh Calkins, J. Peter Van Tintelen, Cynthia A. James

Research output: Contribution to journalArticlepeer-review

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 β 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). β 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.

Original languageEnglish (US)
Pages (from-to)303-312
Number of pages10
JournalHeart
Volume102
Issue number4
DOIs
StatePublished - Feb 1 2016

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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