Department of Cardiology, Lenox Hill Hospital Heart & Lung, Northwell Health System, 100 East 77th Street, 2nd Floor, New York, NY, 10075, USA.
Feinstein Institutes For Medical Research, Manhasset, NY, USA.
BMC Pregnancy Childbirth. 2022 Sep 3;22(1):677. doi: 10.1186/s12884-022-05012-3.
Persistent sinus tachycardia (ST) is frequently encountered during pregnancy and peripartum period and its etiology often remains elusive. We sought to examine the possible association between unexplained persistent ST and obstetric outcomes.
A case control study was conducted using chart review of women admitted in labor to one of 7 hospitals of Northwell Health between January 2015 to June 2021. After excluding women with structurally abnormal hearts, we identified patients with persistent ST during the peripartum period, defined as a heart rate of more than 100 bpm for more than 48 h. A control group was created by randomly subsampling those who did not meet the inclusion criteria for sinus tachycardia. Obstetric outcomes were measured as mother's length of stay (LOS), pre-term labor (PTL), admission to the neonatal ICU (NICU), and whether she received cesarean-section (CS).
Seventy-eight patients with persistent ST were identified, out of 141,769 women admitted for labor throughout the Northwell Health system. 23 patients with ST attributable to infection or hypovolemia from anemia requiring transfusion and 55 with unclear etiology were identified. After adjusting for age and parity, pregnant mothers with ST were 2.35 times more likely to have a CS than those without (95% CI: 1.46-3.81, p = 0.0005) and had 1.38 times the LOS (1.21- 1.56, p < 0.0001). Among mothers with ST, those with unexplained ST were 2.14 times more likely to have a CS (1.22-3.75, p = 0.008).
Among pregnant patients, patients with ST have higher rates of CS.This association is unclear, however potential mechanisms include catecholamine surge, indolent infection, hormonal fluctuations, and medications. More studies are needed to explore the mechanism of ST in pregnant woman to determine the clinical significance and appropriate management.
持续性窦性心动过速（ST）在妊娠和围产期经常发生，其病因往往难以确定。我们试图研究不明原因的持续性 ST 与产科结局之间的可能关联。
使用 2015 年 1 月至 2021 年 6 月期间 Northwell Health 系统的 7 家医院之一入院分娩的女性病历回顾进行病例对照研究。排除心脏结构异常的女性后，我们确定了围产期持续性 ST 的患者，定义为心率超过 100 bpm 超过 48 小时。通过随机抽取不符合窦性心动过速纳入标准的患者创建对照组。测量的产科结局包括母亲的住院时间（LOS）、早产（PTL）、新生儿 ICU（NICU）入院和是否行剖宫产术（CS）。
在 Northwell Health 系统中，在 141769 名入院分娩的女性中，发现了 78 例持续性 ST 患者。23 例 ST 归因于感染或贫血导致的血容量不足需要输血，55 例病因不明。调整年龄和产次后，ST 孕妇行 CS 的可能性是无 ST 孕妇的 2.35 倍（95%CI：1.46-3.81，p=0.0005），且 LOS 增加 1.38 倍（1.21-1.56，p<0.0001）。在有 ST 的母亲中，不明原因的 ST 患者行 CS 的可能性是 2.14 倍（1.22-3.75，p=0.008）。
在妊娠患者中，ST 患者 CS 的发生率较高。这种关联尚不清楚，然而潜在的机制包括儿茶酚胺激增、慢性感染、激素波动和药物。需要进一步研究以探索孕妇 ST 的发生机制，以确定其临床意义和适当的管理。
