Silversides Candice K, Harris Louise, Haberer Kym, Sermer Mathew, Colman Jack M, Siu Samuel C
Pregnancy and Heart Disease Research Program, University Health Network, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Am J Cardiol. 2006 Apr 15;97(8):1206-12. doi: 10.1016/j.amjcard.2005.11.041. Epub 2006 Mar 3.
In women with heart disease, sustained arrhythmias can result in an increased risk to the mother and fetus. The purpose of this study was to determine the recurrence rates of arrhythmias during pregnancy in women with cardiac rhythm disorders and examine the impact on fetal and neonatal outcomes. Women with tachyarrhythmias before pregnancy who underwent obstetric care at the Toronto General and Mount Sinai Hospitals from 1990 to 2002 were included. The recurrence rates of arrhythmias were calculated. A multivariate logistic model was used to identify predictors of fetal complications. Seventy-three women had 87 pregnancies; 36 pregnancies were in women with a history of paroxysmal supraventricular tachycardia, 23 with paroxysmal atrial fibrillation or atrial flutter (AF/Afl), 6 with persistent AF/Afl, and 22 with ventricular tachycardia. In the women in sinus rhythm at baseline, 44% (36 of 81 pregnancies) developed recurrences of tachyarrhythmias during pregnancy or in the early postpartum period. The specific recurrence rates during pregnancy in women with a history of supraventricular tachycardia, paroxysmal AF/Afl, and ventricular tachycardia were 50%, 52%, and 27%, respectively. The 6 women in AF/Afl at baseline remained in this rhythm throughout their pregnancy. Adverse fetal events occurred in 17 of the 87 pregnancies (20%). Adverse fetal events occurred more commonly in women who developed antepartum arrhythmias (RR 3.4, 95% confidence interval 1.0 to 11.0, p = 0.045) compared with those who did not. In conclusion, in women with preexisting cardiac rhythm disorders, exacerbation of arrhythmia during pregnancy is common. Recurrence of arrhythmia during the antepartum period increases the risk of adverse fetal complications, independent of other maternal and fetal risk factors.
在患有心脏病的女性中，持续性心律失常会增加母亲和胎儿的风险。本研究的目的是确定患有心律失常的女性在孕期心律失常的复发率，并研究其对胎儿和新生儿结局的影响。纳入了1990年至2002年期间在多伦多综合医院和西奈山医院接受产科护理的孕前患有快速性心律失常的女性。计算心律失常的复发率。采用多因素逻辑模型确定胎儿并发症的预测因素。73名女性共怀孕87次；36次怀孕的女性有阵发性室上性心动过速病史，23次怀孕的女性有阵发性心房颤动或心房扑动（AF/Afl），6次怀孕的女性有持续性AF/Afl，22次怀孕的女性有室性心动过速。在基线时处于窦性心律的女性中，44%（81次怀孕中的36次）在孕期或产后早期出现快速性心律失常复发。有室上性心动过速、阵发性AF/Afl和室性心动过速病史的女性在孕期的具体复发率分别为50%、52%和27%。6名基线时处于AF/Afl的女性在整个孕期均维持该心律。87次怀孕中有17次（20%）发生不良胎儿事件。与未发生产前心律失常的女性相比，发生产前心律失常的女性更常出现不良胎儿事件（相对危险度3.4，95%置信区间1.0至11.0，P = 0.045）。总之，在已有心律失常的女性中，孕期心律失常加重很常见。产前心律失常复发会增加不良胎儿并发症的风险，且独立于其他母体和胎儿风险因素。
