Characteristics and outcomes of pregnant women without structural heart disease presenting with ventricular arrhythmias

Ventricular arrhythmias (VA) are rare in pregnancy especially in women without a history of cardiac disease. We aimed to describe the characteristics of women without structural heart disease presenting with VA during pregnancy, and the maternal and fetal outcomes. Pregnant women without known structural heart disease referred to a specialized pregnancy program for VA during pregnancy were retrospectively reviewed. VA were defined as 1) high burden PVCs (PVC>500/24 hours), 2) non sustained VT (NSVT, 3 or more beats at a rate>100 bm lasting for less than 30 s) or 3) sustained VT (ventricular tachycardia at a rate>100 bm lasting for more than 30 minutes). Holter recordings, ECGs and telemetry strips were reviewed. Baseline characteristics and maternal and fetal outcomes were collected. Of 81 women referred for VA, 63 had documented VA during pregnancy and were included in the study. Mean age was 34±5 years and 28 (44%) were nulliparous. A total of 20 (32%) women presented for high PVC burden, 18 (28%) for NSVT, and 22 (35%) for both. Three patients (5%) presented with sustained VT requiring emergent intervention. The median Holter PVC burden was 12% (min-max range 1-66%); the median NSVT length was 10 beats± 8 and the median rate was 178±38 bpm. Most of the VA occurred during the second trimester (mean week 24 ±8). Nine (14%) women had an abnormal ECG at baseline. A total of 40 women had documentation of the VA morphology from the 12-lead-ECG and 18 (45%) of them had an origin from the right ventricular outflow tract (RVOT, Figure 1). A total of 41(66%) were treated with betablockers (29 with metoprolol, 3 bisoprolol, 2 nadolol, 5 with propranolol), 2 with verapamil, 2 with flecainide and 1 with amiodarone. Eleven (18%) women required hospital admission (Table 1) and initiation or adjustment of drug therapy. Three patients had thromboembolic events. Of the three patients who presented with sustained arrhythmias, one had symptomatic heart failure and one died during pregnancy. Eight babies and 6 twins (total 14) had a birthweight <2500 gr, four babies were born preterm and 4 required resuscitation at birth. No fetal deaths occurred. Ventricular arrhythmias from the RVOT are common in pregnant women without structural heart disease. Most of the women with non-sustained arrhythmias have favorable outcomes, however, careful fetal and maternal monitoring in a specialized pregnancy program is required.Tabled 1Table 1: Details of hospital admissions (PO-04-227)Patient numberAge at deliveryGA (weeks)SymptomsVA detailsRVOT morphologyTreatmentOutcomes1232329SyncopePre-syncopePVCs, NSVTYesMetoprolol 37.5 mg TIDTransition from verapamil 120 mg TID to flecainide 50 mg TIDDischarged home23512Pre-syncopePVCs, NSVTNo (polymorphic)Metoprolol titration from 50 mg bid to 75 mg BIDDischarged home33512Pre-syncope/palpitationsSustained VTNo (RBBB, QRS axis +60ˆ)IV procainamide+ IV metoprololFlecainide 150 BID+ nadolol 120 ODDischarged home44024Palpitations/shortness of breathPVCs, NSVTYesTransition from metoprolol 25 mg BID to verapamil 240 mg BIDDischarged home53835SyncopeNSVTYesMetoprolol 50 TIDDischarged home63529Pre-syncope/palpitationsSustained VTNo (LBBB, superior axis)Esmolol IV infusionMetoprolol 125 TIDAmiodarone 400 mg ODDischarged home73424Cardiac arrestSustained VTNo (LBBB, QRS axis -30ˆ)CPR + epinephrineDeath83929PalpitationsPVCs, NSVTNo (RBBB, inferior axis)None (patient refused)Discharged home93924PalpitationsNSVTUnknownPropranolol 20 TIDDischarged home103835PalpitationsPVCsYesNone (patient refused)Discharged home113113Pre-syncope/palpitationsNSVTNo (LBBB, superior axis)Metoprolol 37.5 mg TIDDischarged home Open table in a new tab