Abstract 19203: A Case of New Supraventricular Tachycardia During Pregnancy, With the Development of Post-partum Eclampsia, Torsades De Pointes, and Long Qt Syndrome: Is There a Connection?
Background: There is a mechanistic link between QT prolongation and the development of TdP. Women with LQTS have an increased risk of serious cardiac arrhythmias during the postpartum period,however,there is limited data on the effects of pregnancy on those without a prolonged QT prior to delivery.
Case Description: The patient is a 22 y/o female with no history of arrhythmia.During pregnancy she had three episodes of SVT,each prompting hospital admissions.ECG showed a heart rate of 148-163bpm,a QTc of 390 to 410ms,and laboratory data a magnesium level of 1.6.On day 3 after a scheduled cesarean section, she suffered a eclamptic seizure and then a Tdp induced cardiac arrest.Magnesium was immediately given.CPR was performed for 31 minutes until return of spontaneous circulation was achieved.The patient had an extended ICU course but was eventually discharged home with her newborn twins,a subcutaneous implantable cardiac defibrillator (S-ICD),multiple postpartum ECGs showing QTc of 493 to 524ms,and a diagnosis of LQTS.
Discussion: Pregnancy increases or precipitate cardiac arrhythmias not previously present in otherwise healthy females. In women with LQTS, there have been studies that have shown significant increases in arrhythmias and SCD during the 9 months postpartum.Also recognized are silent forms of congenital LQTS in which patients are arrhythmia free until exposed to a precipitant.5-10% of patients who develop drug-induced TdP are silent carriers of gene mutations related to LQTS, suggesting a “second hit” can uncover the LQTS phenotype despite a “normal” QTc in the unprovoked state. This emphasizes the importance of other potential ‘hits’ that can uncover a LQTS, particularly relevant to this case, the postpartum period.To our knowledge,this is the first case of a simultaneously occurring eclamptic seizure and TdP induced cardiac arrest both successfully treated with IV magnesium.This is also the first report,to our knowledge,of multiple episodes of SVT occurring during pregnancy in a patient who subsequently developed postpartum eclampsia,TdP,SVT,and LQTS. Further studies are needed to identify patients at high risk for postpartum induced LQTS/TdP and if SVT during pregnancy is a risk factor, as well as twin births and Cesarian deliveries.
Author Disclosures: T. Rambhatla: None. A. Kodra: None. E. Levine: None. S. Mountantonakis: None. K. Bhasin: None. N. Skipitaris: None.
- © 2014 by American Heart Association, Inc.