Niwa Koichiro, Tateno Shigeru, Akagi Teiji, Himeno Wakako, Kawasoe Yasutaka, Tatebe Shunsuke, Matsuo Kozo, Gatzoulis Michael A, Nakazawa Makoto
Department of Pediatrics, Chiba Cardiovascular Center, Japan.
Int J Cardiol. 2007 Nov 15;122(2):143-8. doi: 10.1016/j.ijcard.2006.11.045. Epub 2007 Jan 16.
Tachyarrhythmia during pregnancy may have an adverse effect on the mother and the fetus. Heart rate variability (HRV) is a significant marker of autonomic nervous function and may predict tachyarrhythmia. HRV and incidence of arrhythmia in women with repaired congenital heart disease (CHD) during pregnancy were examined.
Twenty-eight patients with repaired CHD (35 pregnancies, age: 26+/-3.5 years at their first pregnancy, 22+/-6.2 years post-repair) and 19 healthy pregnant volunteers (controls, 19 pregnancies, age: 28+/-5.5 years) were enrolled. Holter monitoring and laboratory tests were examined at 28+/-4 weeks of gestation and 22+/-13 weeks postpartum in patients and 28+/-3 weeks of gestation in controls. Time and frequency variables of HRV were analyzed.
Compared with controls and postpartum, there was a significantly higher incidence of tachyarrhythmia during pregnancy in women with CHD (4 episodes of supraventricular tachyarrhythmia (SVT) and 5 of non-sustained ventricular tachycardia, P=0.02). HR response in tetralogy of Fallot was impaired (781+/-50 ms, P=0.02). Most of HRV variables were significantly suppressed (average RR 740+/-64 ms, SDRR 99+/-22 ms, low and high frequency domains (341+/-165 ms2 and 256+/-181 ms2) (P<0.05). Reduced SDRR and high frequency domains were observed in patients with tachyarrhythmia. Furthermore, there were increased left ventricular end-diastolic dimensions 48+/-5 mm (P=0.001) and atrial natriuretic peptide levels 33+/-13 pg/ml (P=0.01) in the CHD patients compared with postpartum levels.
Impaired autonomic nervous activity, volume overload of the heart and operative scar all play a contributory role in higher incidence of tachyarrhythmia during pregnancy in patients with repaired CHD compared to healthy pregnant controls. Close monitoring of patients with CHD for tachyarrhythmia during pregnancy is, thus, warranted.
孕期快速性心律失常可能对母亲和胎儿产生不利影响。心率变异性（HRV）是自主神经功能的重要指标，可能预测快速性心律失常。本研究检测了妊娠期间先天性心脏病（CHD）修补术后女性的HRV及心律失常发生率。
纳入28例CHD修补术后患者（35次妊娠，首次妊娠年龄：26±3.5岁，修补术后年龄：22±6.2岁）和19名健康妊娠志愿者（对照组，19次妊娠，年龄：28±5.5岁）。患者在妊娠28±4周和产后22±13周进行动态心电图监测和实验室检查，对照组在妊娠28±3周进行检查。分析HRV的时间和频率变量。
与对照组和产后相比，CHD女性孕期快速性心律失常的发生率显著更高（4例室上性快速性心律失常（SVT）和5例非持续性室性心动过速，P = 0.02）。法洛四联症患者的心率反应受损（781±50毫秒，P = 0.02）。大多数HRV变量被显著抑制（平均RR 740±64毫秒，SDRR 99±22毫秒，低频和高频域（341±165平方毫秒和256±181平方毫秒）（P < 0.05）。快速性心律失常患者的SDRR和高频域降低。此外，与产后水平相比，CHD患者的左心室舒张末期内径增加至48±5毫米（P = 0.001），心房利钠肽水平增加至33±13皮克/毫升（P = 0.01）。
与健康妊娠对照组相比，自主神经活动受损、心脏容量超负荷和手术瘢痕均导致CHD修补术后患者孕期快速性心律失常的发生率更高。因此，孕期对CHD患者进行快速性心律失常的密切监测是必要的。
