Boulé Stéphane, Ovart Lionel, Marquié Christelle, Botcherby Edward, Klug Didier, Kouakam Claude, Brigadeau François, Guédon-Moreau Laurence, Wissocque Ludivine, Meurice Jonathan, Lacroix Dominique, Kacet Salem
Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France.
Europace. 2014 Nov;16(11):1587-94. doi: 10.1093/europace/euu036. Epub 2014 Mar 3.
To describe obstetric/neonatal and cardiac outcomes for a cohort of women carrying implantable cardioverter-defibrillators (ICDs) during pregnancy.
All women in routine follow-up at our institution for ICD implantation who became pregnant between 2006 and 2013 were included in this study. All ICDs were pre-pectoral devices with bipolar endocardial leads. Obstetric/neonatal and cardiac outcomes were assessed during pregnancy and post-partum. Twenty pregnancies were conceived by 12 women carrying ICD devices, 14 of which resulted in live births and none in maternal death. Seven of these women had structural cardiomyopathies and five had channelopathies. No device-related complications were recorded. Twelve shocks (nine transthoracic and three from ICDs) were experienced during pregnancy by two women, one of whom miscarried shortly afterwards at 4 weeks gestation. One stillbirth, three miscarriages and one termination were recorded for women with long QT syndrome, repaired tetralogy of Fallot and repaired Laubry-Pezzi syndrome, respectively. Intrauterine growth restriction, low birth weight, and neonatal hypoglycaemia were recorded in four, three, and five pregnancies, respectively.
Pregnancy had no effect on ICD operation and no evidence was found to link ICD carriage with adverse pregnancy outcomes, although one miscarriage may have been induced by ICD shock therapy. A worsening of cardiac condition occurs in specific cardiac diseases and β-blocker therapy should be continued for all women carrying ICDs in pregnancy as the benefits outweigh the risks of taking this medication.
描述孕期植入植入式心脏复律除颤器（ICD）的一组女性的产科/新生儿及心脏结局。
本研究纳入了2006年至2013年间在我院接受ICD植入常规随访且怀孕的所有女性。所有ICD均为带有双极心内膜导线的胸前区植入装置。在孕期及产后评估产科/新生儿及心脏结局。12名携带ICD装置的女性怀孕20次，其中14次分娩活婴，无孕产妇死亡。这些女性中7例患有结构性心肌病，5例患有通道病。未记录到与装置相关的并发症。两名女性在孕期经历了12次电击（9次经胸电击和3次ICD电击），其中一名女性在孕4周后不久流产。分别记录到长QT综合征、法洛四联症修补术后和劳布里 - 佩齐综合征修补术后的女性发生1例死产、3例流产和1例终止妊娠。分别有4例、3例和5例妊娠记录到胎儿生长受限、低出生体重和新生儿低血糖。
妊娠对ICD的运行无影响，未发现证据表明携带ICD与不良妊娠结局有关，尽管有1例流产可能是由ICD电击治疗诱发的。特定心脏病会出现心脏状况恶化，对于所有孕期携带ICD的女性应继续使用β受体阻滞剂治疗，因为用药的益处大于风险。
