Topf Albert, Bacher Nina, Kopp Kristen, Mirna Moritz, Larbig Robert, Brandt Mathias C, Kraus Johannes, Hoppe Uta C, Motloch Lukas J, Lichtenauer Michael
Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria.
Division of Cardiology, Hospital Maria Hilf Mönchengladbach, 41063 Mönchengladbach, Germany.
J Clin Med. 2021 Apr 14;10(8):1675. doi: 10.3390/jcm10081675.
With the advent of implantable cardioverter-defibrillator (ICD) technology in recent decades, patients with inherited or congenital cardiomyopathy have a greater chance of survival into adulthood. Women with ICDs in this group are now more likely to reach reproductive age. However, pregnancy represents a challenge for clinicians, as no guidelines for the treatment of pregnant women with an ICD are currently available.
To analyze this issue, we performed a systematic screening of the literature using the keywords: pregnancy with ICD, lead fracture in pregnancy, lead thrombi in pregnancy, ventricular tachycardia in pregnancy, inappropriate shocks in pregnancy, ICD discharge in pregnancy and ICD shock in pregnancy. Of 1101 publications found, 27 publications were eligible for further analysis (four retrospective trials and 23 case reports).
According to physiological changes in pregnancy, resulting in an increase in heart rate and cardiac output, a vulnerability for malignant arrhythmias and device-related complications in ICD carriers might be suspected. While the literature is limited on this issue, maternal complications including arrhythmia burden with following ICD therapies, thromboembolic events and lead complications as well as inappropriate shock therapy have been reported. According to the limited available studies, associated risk seems not to be more frequent than in the general population and depends on the underlying cardiac pathology. Furthermore, worsening of heart failure and related cardiovascular disease have been reported with associated risk of preterm delivery. These observations are exaggerated by restricted applications of diagnostics and treatment due to the risk of fetal harm in this population.
Due to limited data on management of ICDs during pregnancy, further scientific investigations are required. Consequently, careful risk assessment with individual risk evaluation and close follow ups with interdisciplinary treatment are recommended in pregnant ICD carriers.
近几十年来，随着植入式心脏转复除颤器（ICD）技术的出现，患有遗传性或先天性心肌病的患者成年后存活的机会更大。该群体中植入ICD的女性现在更有可能达到生育年龄。然而，怀孕对临床医生来说是一项挑战，因为目前尚无针对植入ICD的孕妇的治疗指南。
为分析此问题，我们使用关键词“妊娠合并ICD”“妊娠时导线断裂”“妊娠时导线血栓形成”“妊娠时室性心动过速”“妊娠时不适当电击”“妊娠时ICD放电”和“妊娠时ICD电击”对文献进行了系统筛选。在找到的1101篇出版物中，有27篇符合进一步分析的条件（4项回顾性试验和23篇病例报告）。
根据妊娠时的生理变化，心率和心输出量增加，可能怀疑ICD携带者易发生恶性心律失常和与设备相关的并发症。虽然关于这个问题的文献有限，但已报告了包括ICD治疗后的心律失常负担、血栓栓塞事件、导线并发症以及不适当电击治疗等母体并发症。根据现有的有限研究，相关风险似乎并不比一般人群更频繁，并且取决于潜在的心脏病理情况。此外，已有报告称心力衰竭和相关心血管疾病恶化，并伴有早产风险。由于该人群存在胎儿伤害风险，诊断和治疗的应用受到限制，这些观察结果被夸大了。
由于妊娠期间ICD管理的数据有限，需要进一步的科学研究。因此，建议对植入ICD的孕妇进行仔细的风险评估、个体风险评估，并进行密切随访和多学科治疗。
