Pregnancy and newborn outcomes in arrhythmogenic right ventricular cardiomyopathy/dysplasia

Int J Cardiol. 2018 May 1:258:172-178. doi: 10.1016/j.ijcard.2017.11.067.

Abstract

Introduction: The prognosis of pregnancy in patients with Arrhythmogenic Right Ventricular Cardiomyopathy/dysplasia (ARVC/D) is poorly documented. The aim of this study is to assess the cardiac risks during pregnancy and the impact of ARVC/D on fetuses/neonates/children.

Methods: We included all ARVC/D women with a history of pregnancy from the ARVC/D Pitié-Salpêtrière registry. Cardiac and obstetrical events having occurred during pregnancy/delivery/post-partum periods and neonatal data/follow-up were collected.

Results: Sixty pregnancies in twenty-three patients were identified between 1968 and 2016. Only two major non-fatal cardiac events (one sustained non-documented tachycardia and one ventricular tachycardia) were recorded during pregnancy in two different mothers (3% of pregnancies, 9% of mothers). None occurred during delivery or in the postpartum period. No mother developed heart failure. Beta-blocker therapy during pregnancy (n=15) was associated with lower birthweight (2730 vs 3400g, p=0.004). Only two preterm deliveries occurred, unrelated to cardiac condition. Caesarean section was performed in 13% of cases. Premature sudden-death occurred in 10% (n=5) of children before 25years-old including two in the first year of life.

Conclusion: ARVC/D is associated with a low rate of major cardiac events during pregnancy and vaginal delivery appears safe. The risk of sustained ventricular arrhythmia seems poorly predictable and supports the continuation of beta-blockers during pregnancy. Major cardiac events were frequent in childhood, justifying close cardiac monitoring.

Keywords: ARVC; ARVD; Cardiomyopathy; Pregnancy; Ventricular arrhythmias.

MeSH terms

  • Abortion, Spontaneous / diagnostic imaging
  • Abortion, Spontaneous / epidemiology
  • Abortion, Spontaneous / prevention & control
  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • Arrhythmogenic Right Ventricular Dysplasia / diagnostic imaging*
  • Arrhythmogenic Right Ventricular Dysplasia / drug therapy
  • Arrhythmogenic Right Ventricular Dysplasia / epidemiology*
  • Female
  • Humans
  • Infant, Newborn
  • Middle Aged
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / diagnostic imaging*
  • Pregnancy Complications, Cardiovascular / drug therapy
  • Pregnancy Complications, Cardiovascular / epidemiology*
  • Pregnancy Outcome / epidemiology*
  • Premature Birth / diagnostic imaging
  • Premature Birth / epidemiology
  • Premature Birth / prevention & control
  • Retrospective Studies
  • Young Adult

Substances

  • Adrenergic beta-Antagonists