This article is more than 5 years old. Information may no longer be current.
Atrial fibrillation/flutter rare, increases complication risk in pregnant women with heart disease
Click Here to Manage Email Alerts
Atrial flutter or atrial fibrillation occurred infrequently in a large prospective registry of pregnant women with structural heart disease, but was associated with increased risk for maternal mortality and fetal complications in a recent analysis.
The researchers evaluated 1,321 pregnant women from 60 hospitals in 28 countries enrolled in the European Registry of Pregnancy and Cardiac Disease between January 2008 and June 2011. All participants had cardiomyopathy or congenital, valvular or ischemic heart disease. Incidence of AF or atrial flutter was evaluated during pregnancy.
AF or atrial flutter occurred in 1.3% of the population, with 61.5% of cases occurring during the second trimester. Maternal mortality occurred in two cases. Pre-pregnancy risk factors associated with AF/atrial flutter on univariable analysis included prior AF or atrial flutter (OR = 7.1; 95% CI, 1.5-32.8), mitral valvular heart disease (OR = 6.9; 95% CI, 2.6-18.3), treatment with beta-blockers (OR = 3.3; 95% CI; 1.2-9) and the presence of lesions on the left side (OR = 2.9; 95% CI, 1-8.3). Congenital heart disease was associated with reduced likelihood of AF or atrial flutter (OR = 0.3; 95% CI, 0.1-0.8).
HF occurred at similar rates between women with and without AF or atrial flutter, as did cardiac and obstetric complications. However, maternal mortality was more common among those with AF or atrial flutter (11.8% vs. 0.9%; P = .01). AF or atrial flutter also was associated with low birth weight (35% vs. 14%; P = .02).
“Although rare in pregnancy, the management of [AF or atrial flutter] in women with heart disease poses a unique challenge to physicians,” the researchers wrote. “A multidisciplinary approach with close monitoring of mother and baby and timely therapy is required to optimize maternal and fetal outcomes. Despite our data, experience with the management of such arrhythmias remains limited and further studies in larger numbers of patients are still awaited.”
In a related editorial, Candice K. Silversides, MS, MD, and Danna A. Spears, MD, both of the University of Toronto Pregnancy and Heart Disease Program and the Mount Sinai Hospital and University Health Network in Toronto, also called for further study. “Multicenter collaborative studies such as [this] continue to help improve our understanding of pregnancy risk in women with rare conditions and rare complications.”
They noted the “concerning” rates of morbidity and mortality among women with AF or atrial flutter, as well as fetal and neonatal complications. “The maternal mortality in this study underscores the need for appropriate preconception counseling, prepregnancy interventions when appropriate, frequent surveillance during pregnancy and the need for pregnancy care by a multidisciplinary team with expertise in pregnancy and heart disease,” Silversides and Spears wrote. – by Adam Taliercio
Disclosure: The researchers, Silversides and Spears report no relevant financial disclosures.
Click Here to Manage Email Alerts