Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Japan.
Circ J. 2013;77(5):1166-70. doi: 10.1253/circj.cj-12-1275. Epub 2012 Dec 29.
There are few studies of pregnancy and delivery in patients with an implantable cardioverter-defibrillator (ICD). The purpose of this study was to investigate maternal and fetal outcome in these patients.
Six pregnant women with an ICD were retrospectively reviewed. All women underwent implantation of an ICD before pregnancy and delivered at the National Cerebral and Cardiovascular Center. The mean age at pregnancy and the mean follow-up period after ICD implantation were 28±3 years old and 5±3 years, respectively. There was no device-related complication during pregnancy. In 4 women, the number of tachyarrhythmias such as non-sustained ventricular tachycardia increased after the end of the second trimester of pregnancy and anti-arrhythmic medications were gradually increased. No patient received discharges or shocks from the ICD during pregnancy, however, and only one required anti-tachycardia pacing at 27 weeks' gestation. Mean gestational age at delivery was 37±2 weeks and all deliveries were by cesarean section, including 5 as emergency deliveries due to a fetal indication. After delivery, 2 mothers had reduced cardiac function and 1 received an ICD shock for the first time.
Pregnancy did not increase the risk of an ICD-related complication under appropriate management. Additional caution might be required in the postpartum period as well as during pregnancy and labor.
目前鲜有关于植入式心脏复律除颤器（ICD）患者妊娠和分娩的研究。本研究旨在探讨此类患者的母婴结局。
回顾性分析了 6 例患有 ICD 的妊娠女性。所有女性均在妊娠前植入 ICD，并在国立循环器病研究中心分娩。妊娠时的平均年龄和 ICD 植入后的平均随访时间分别为 28±3 岁和 5±3 年。妊娠期间无器械相关并发症。4 例女性在妊娠后期，非持续性室性心动过速等快速性心律失常的次数增加，抗心律失常药物逐渐增加。然而，妊娠期间无患者 ICD 放电或电击，仅有 1 例在 27 周妊娠时需要抗心动过速起搏。分娩时的平均孕龄为 37±2 周，所有分娩均为剖宫产，其中 5 例因胎儿指征而行急症剖宫产。分娩后，有 2 位母亲心功能下降，1 位首次接受 ICD 电击。
在适当的管理下，妊娠并未增加与 ICD 相关的并发症风险。在产后以及妊娠和分娩期间可能需要更加谨慎。
