Predicting postpartum cardiac events in pregnant women with complete atrioventricular block. Issue 4 (October 2019)

• Record Type: Journal Article
• Authors: Nakashima, Ayaka; Miyoshi, Takekazu; Aoki-Kamiya, Chizuko; Nishio, Miho; Horiuchi, Chinami; Tsuritani, Mitsuhiro; Iwanaga, Naoko; Katsuragi, Shinji; Neki, Reiko; Ikeda, Tomoaki; Yoshimatsu, Jun
• Is Part Of: Journal of cardiology. Volume 74:Issue 4(2019)
• Page Start: 347
• Page End: 352
• Publication Date: 2019-10
• Subjects: Complete atrioventricular block -- Pacemaker -- Ventricular pause -- Postpartum -- Pregnancy; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2019.04.002
• Languages: English
• ISSNs: 0914-5087

Abstract

Highlights: All cardiac events occurred during the postpartum period among women with complete atrioventricular block (CAVB). Postpartum cardiac events occurred in 14.3% of pregnancies with CAVB. Ventricular pause and family history are predictors of postpartum cardiac events. No further increases in heart rate were found during the second and third trimesters. Close follow-up is needed during the postpartum period for high-risk CAVB women. Abstract: Background: Women with complete atrioventricular block (CAVB) can tolerate hemodynamic changes during pregnancy; however, the incidence of cardiac events in women with CAVB may increase after delivery. The aim of this study was to investigate predictive factors for postpartum cardiac events in pregnant women with CAVB. Methods and results: Pregnant women with CAVB who received perinatal management at a tertiary cardiac center from 1981 to 2015 were retrospectively reviewed. Univariate and multivariate logistic analyses of postpartum cardiac events were performed. Postpartum cardiac event was defined as cardiopulmonary arrest, cardiac failure, or the need for permanent pacemaker implantation (p-PMI) within 3 months after delivery. A total of 63 pregnancies in 36 women with CAVB were included in this study; 25 had undergone p-PMI before pregnancy. Regardless of p-PMI status, women with CAVB had no further increases in heart rate during the second and third trimesters. No heart failure was found during pregnancy and delivery. Postpartum cardiac events occurred in 9 pregnancies (14.3%) in 8 women with CAVB; 3 had cardiac failure and p-PMI, 3 had cardiac failure, 2 required p-PMI, and 1 had cardiopulmonary arrest. Multivariate analysis showed that perinatal ventricular pause (odds ratio 11.60, 95% confidence interval 1.90–82.18, p < 0.01) and family history of CAVB (odds ratio 10.59, 95% confidence interval 1.36–90.56, p = 0.03) were associated with postpartum cardiac events. Conclusions: All cardiac events occurred during the postpartum period among women with CAVB, and ventricular pause during the perinatal period and a family history of CAVB were predictors of postpartum cardiac events. Close follow-up should be considered during the postpartum period for women with high-risk CAVB.