Abstract 18388: Is Pregnancy Associated with an Increased Risk of Arrhythmias and Disease Progression in Arrhythmogenic Right Ventricular Cardiomyopathy?
BACKGROUND:The risk of pregnancy in women with ARVC is an important clinical issue for which systematic data have not been reported so far.
OBJECTIVES: to assess the morbidity and mortality in nulliparous and multiparous women affected by Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC).
METHODS: The study cohort included 27 women affected by ARVC with one or more live births, for a total of 47 live births. Maternal mortality and morbidity related to ARVC during pregnancy was evaluated with a follow-up programme, consisting of personal and family history, ECG, signal-averaged ECG, 24-h Holter and echocardiogram within three years of their pregnancy. The symptoms considered were dyspnoea, asthenia and palpitations. Moreover in 15 patients with >1 pregrancies, clinical and instrumental findings detected at the time of the first and the second pregnancy were compared. Finally, data of 13 nulliparous ARVC patients (mean age 32,3±5yrs) were correlated to those of 10 multiparous patients with the same age (34,9± 3,3 yrs).
RESULTS: No pregnancy-related death occurred. In the 27 patients evaluated within close proximity of their first pregnancy, 4 (14%) showed worsening of arrhythmias during pregnancy. All 4 patients had severe form of the disease. One patient experienced a sustained ventricular tachycardia 50 days after delivery. No patient complained of worsening symptoms. In the 15 patients who had more than one pregnancy, the comparison between the first and the second pregnancy demonstrated worsening of symptoms (P=0,05) and arrhythmias (P=0,03) after the second delivery. Similarly, the comparison between nulliparous and mutiparous ARVC patients demonstrated a significant dilatation of the Right Ventricular Outflow Tract (RVOT1= 21mm/m2; p=0,03) as well as worsening of symptoms (P=0,05) and arrhythmias (p=0,03) after the second pregnancy.
CONCLUSIONS: Maternal mortality is not increased in patients with ARVC compared with the general population. During gestation a worsening of arrhythmic pattern is more common in subjects with a severe form of the disease. A second pregnancy seems to be associated with worsening of clinical and instrumental features of the disease. Pre-conception planning and risk assessment are essential.
- © 2012 by American Heart Association, Inc.