Pregnancy and newborn outcomes in arrhythmogenic right ventricular cardiomyopathy/dysplasia

• Published in: International journal of cardiology 2018-05, Vol.258, p.172-178
• Main Authors: Gandjbakhch, E., Varlet, E., Duthoit, G., Fressart, V., Charron, P., Himbert, C., Maupain, C., Bordet, C., Hidden-Lucet, F., Nizard, J.
• Format: Article
• Language: English
• Subjects: ARVC; ARVD; Cardiomyopathy; Pregnancy; Ventricular arrhythmias
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2017.11.067

The prognosis of pregnancy in patients with Arrhythmogenic Right Ventricular Cardiomyopathy/dysplasia (ARVC/D) is poorly documented. The aim of this study is to assess the cardiac risks during pregnancy and the impact of ARVC/D on fetuses/neonates/children. We included all ARVC/D women with a history of pregnancy from the ARVC/D Pitié-Salpêtrière registry. Cardiac and obstetrical events having occurred during pregnancy/delivery/post-partum periods and neonatal data/follow-up were collected. Sixty pregnancies in twenty-three patients were identified between 1968 and 2016. Only two major non-fatal cardiac events (one sustained non-documented tachycardia and one ventricular tachycardia) were recorded during pregnancy in two different mothers (3% of pregnancies, 9% of mothers). None occurred during delivery or in the postpartum period. No mother developed heart failure. Beta-blocker therapy during pregnancy (n=15) was associated with lower birthweight (2730 vs 3400g, p=0.004). Only two preterm deliveries occurred, unrelated to cardiac condition. Caesarean section was performed in 13% of cases. Premature sudden-death occurred in 10% (n=5) of children before 25years-old including two in the first year of life. ARVC/D is associated with a low rate of major cardiac events during pregnancy and vaginal delivery appears safe. The risk of sustained ventricular arrhythmia seems poorly predictable and supports the continuation of beta-blockers during pregnancy. Major cardiac events were frequent in childhood, justifying close cardiac monitoring. •ARVC/D is associated with a low rate of major cardiac events during pregnancy and vaginal delivery appears safe.•No haemodynamic compromise was observed during pregnancy or post-partum period.•The risk of sustained ventricular arrhythmia seems poorly predictable and supports the continuation of beta-blockers during pregnancy.•We recommend a multidisciplinary care with obstetricians, cardiologists, anaesthesiologist, and paediatricians.•The follow-up of children revealed frequent major cardiac events including SCD in 10%, justifying close cardiac monitoring.