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Topf A, Bacher N, Kopp K, Mirna M, Larbig R, Brandt MC, Kraus J, Hoppe UC, Motloch LJ, Lichtenauer M. Management of Implantable Cardioverter-Defibrillators during Pregnancy-A Systematic Review. J Clin Med 2021; 10:jcm10081675. [PMID: 33919684 PMCID: PMC8069958 DOI: 10.3390/jcm10081675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022] Open
Abstract
Background: 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. Methods: 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). Results: 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. Conclusions: 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.
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Affiliation(s)
- Albert Topf
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
- Correspondence:
| | - Nina Bacher
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
| | - Kristen Kopp
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
| | - Moritz Mirna
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
| | - Robert Larbig
- Division of Cardiology, Hospital Maria Hilf Mönchengladbach, 41063 Mönchengladbach, Germany;
- Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany
| | - Mathias C. Brandt
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
| | - Johannes Kraus
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
| | - Uta C. Hoppe
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
| | - Lukas J. Motloch
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
| | - Michael Lichtenauer
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (N.B.); (K.K.); (M.M.); (M.C.B.); (J.K.); (U.C.H.); (L.J.M.); (M.L.)
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Golia E, Gravino R, Rea A, Masarone D, Rubino M, Cirillo A, Pacileo R, Fratta F, Russo MG, Pacileo G, Limongelli G. Management of pregnancy in cardiomyopathies and heart failure. Future Cardiol 2017; 13:81-96. [DOI: 10.2217/fca-2015-0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pregnancy exposes women with inherited cardiomyopathies to increased risk for arrhythmias and heart failure. In asymptomatic patients with inherited cardiomyopathies, pregnancy is generally well tolerated. Preconception evaluation, risk assessment and proper counseling by a team of experienced physicians are mandatory in managing women with inherited cardiomyopathies planning pregnancy. In this paper, we reviewed the clinical course, risk assessment and management during pregnancy of women with cardiomyopathies.
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Affiliation(s)
- Enrica Golia
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Rita Gravino
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Alessandra Rea
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Daniele Masarone
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Marta Rubino
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Annapaola Cirillo
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Roberta Pacileo
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Fiorella Fratta
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Maria Giovanna Russo
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Giuseppe Pacileo
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
| | - Giuseppe Limongelli
- Cardiologia SUN – Heart Failure Unit, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
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Abstract
Maternal cardiac disease complicates approximately 1-2% of all pregnancies in the United States. Just as during the antepartum period, in the immediate period surrounding delivery, obstetrical patients with cardiac disease (both congenital and acquired) will have specialized needs, tailored to the patient and her specific lesion. While the basic principles of labor and delivery management protocols are relevant to this subgroup of patients, there are certain areas in which adjustments must be made. These include endocarditis prophylaxis, recent anticoagulation, fluid management, and the need for increased maternal cardiac monitoring. Awareness of the challenges of the intrapartum period combined with a multi-disciplinary approach from anesthesia, cardiology, and the obstetrical provider will optimize the patient for a safe delivery.
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Affiliation(s)
- Heather Levin
- Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 W 168th St, PH-16, New York, NY
| | - Anita LaSala
- Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 W 168th St, PH-16, New York, NY.
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Noda T, Kurita T, Nitta T, Abe H, Watanabe S, Furushima H, Matsumoto N, Toyoshima T, Shimizu A, Mitamura H, Ohe T, Aizawa Y. Appropriate duration of driving restrictions after inappropriate therapy from implantable cardiac shock devices-interim analysis of the Nippon Storm Study. Circ J 2014; 78:1989-91. [PMID: 25030300 DOI: 10.1253/circj.cj-14-0589] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Little is known regarding the appropriate duration for driving restrictions after inappropriate implantable cardiac shock device (ICSD) therapy. METHODS AND RESULTS We evaluated the Nippon Storm Study data, and found that inappropriate ICSD therapy occurred in 114 (7.6%) patients during a median follow-up of 464 days. Among those patients, 25 experienced further inappropriate ICSD therapy during a subsequent median follow-up of 380 days. Time-dependent recurrence of inappropriate ICSD therapy occurred in 19 (76%) patients within 180 days. CONCLUSIONS The interval for driving restrictions after inappropriate ICSD therapy can be reduced.
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Affiliation(s)
- Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Boulé S, Ovart L, Marquié C, Botcherby E, Klug D, Kouakam C, Brigadeau F, Guédon-Moreau L, Wissocque L, Meurice J, Lacroix D, Kacet S. Pregnancy in women with an implantable cardioverter-defibrillator: is it safe? Europace 2014; 16:1587-94. [PMID: 24596396 DOI: 10.1093/europace/euu036] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To describe obstetric/neonatal and cardiac outcomes for a cohort of women carrying implantable cardioverter-defibrillators (ICDs) during pregnancy. METHODS AND RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Stéphane Boulé
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - Lionel Ovart
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - Christelle Marquié
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - Edward Botcherby
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - Didier Klug
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France Faculty of medicine, University of Lille 2, 59045 Lille, France
| | - Claude Kouakam
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - François Brigadeau
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - Laurence Guédon-Moreau
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - Ludivine Wissocque
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France Faculty of medicine, University of Lille 2, 59045 Lille, France
| | - Jonathan Meurice
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France
| | - Dominique Lacroix
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France Faculty of medicine, University of Lille 2, 59045 Lille, France
| | - Salem Kacet
- Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France Faculty of medicine, University of Lille 2, 59045 Lille, France
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