致心律失常性右室心肌病女性的妊娠过程及结局
Pregnancy course and outcomes in women with arrhythmogenic right ventricular cardiomyopathy.
作者信息
Hodes Anke R, Tichnell Crystal, Te Riele Anneline S J M, Murray Brittney, Groeneweg Judith A, Sawant Abhishek C, Russell Stuart D, van Spaendonck-Zwarts Karin Y, van den Berg Maarten P, Wilde Arthur A, Tandri Harikrishna, Judge Daniel P, Hauer Richard N W, Calkins Hugh, van Tintelen J Peter, James Cynthia A
机构信息
Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA Department of Cardiology/Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
出版信息
Heart. 2016 Feb 15;102(4):303-12. doi: 10.1136/heartjnl-2015-308624. Epub 2015 Dec 30.
OBJECTIVES
To characterise pregnancy course and outcomes in women with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C).
METHODS
From a combined Johns Hopkins/Dutch ARVD/C registry, we identified 26 women affected with ARVD/C (by 2010 Task Force Criteria) during 39 singleton pregnancies >13 weeks (1-4 per woman). Cardiac symptoms, treatment and episodes of sustained ventricular arrhythmias (VAs) and heart failure (HF) ≥ Class C were characterised. Obstetric outcomes were ascertained. Incidence of VA and HF were compared with rates in the non-pregnant state. Long-term disease course was compared with 117 childbearing-aged female patients with ARVD/C who had not experienced pregnancy with ARVD/C.
RESULTS
Treatment during pregnancy (n=39) included β blockers (n=16), antiarrhythmics (n=6), diuretics (n=3) and implantable cardioverter defibrillators (ICDs) (n=28). In five pregnancies (13%), a single VA occurred, including two ICD-terminated events. Arrhythmias occurred disproportionately in probands without VA history (p=0.045). HF, managed on an outpatient basis, developed in two pregnancies (5%) in women with pre-existing overt biventricular or isolated right ventricular disease. All infants were live-born without major obstetric complications. Caesarean sections (n=11, 28%) had obstetric indications, except one (HF). β Blocker therapy was associated with lower birth weight (3.1±0.48 kg vs 3.7±0.57 kg; p=0.002). During follow-up children remained healthy (median 3.4 years), and mothers were without cardiac mortality or transplant. Neither VA nor HF incidence was significantly increased during pregnancy. ARVD/C course (mean 6.5±5.6 years) did not differ based on pregnancy history.
CONCLUSIONS
While most pregnancies in patients with ARVD/C were tolerated well, 13% were complicated by VA and 5% by HF.
目的
描述致心律失常性右室发育不良/心肌病（ARVD/C）女性患者的妊娠过程及结局。
方法
从约翰霍普金斯大学/荷兰ARVD/C联合登记处，我们确定了26名在39次单胎妊娠（孕周>13周，每名女性1 - 4次妊娠）期间受ARVD/C影响（根据2010年工作组标准）的女性。对心脏症状、治疗以及持续性室性心律失常（VA）发作和≥C级心力衰竭（HF）情况进行了描述。确定了产科结局。将VA和HF的发生率与非妊娠状态下的发生率进行比较。将长期疾病过程与117名未经历过ARVD/C妊娠的育龄期ARVD/C女性患者进行比较。
结果
孕期治疗（n = 39）包括β受体阻滞剂（n = 16）、抗心律失常药（n = 6）、利尿剂（n = 3）和植入式心脏复律除颤器（ICD）（n = 28）。5次妊娠（13%）发生了单次VA，包括2次ICD终止的事件。心律失常在无VA病史的先证者中发生比例过高（p = 0.045）。在已有明显双心室或孤立右心室疾病的女性中，2次妊娠（5%）出现了需门诊治疗的HF。所有婴儿均存活，无重大产科并发症。剖宫产（n = 11，28%）有产科指征，除1例（HF）外。β受体阻滞剂治疗与较低出生体重相关（3.1±0.48 kg vs 3.7±0.57 kg；p = 0.002）。随访期间儿童保持健康（中位时间3.4年），母亲无心脏死亡或移植情况。孕期VA和HF发生率均未显著增加。ARVD/C病程（平均6.5±5.6年）不因妊娠史而不同。
结论
虽然ARVD/C患者的大多数妊娠耐受性良好，但13%的妊娠并发VA，5%并发HF。
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