Author + information
- Received September 10, 2018
- Revision received October 31, 2018
- Accepted October 31, 2018
- Published online March 18, 2019.
- Christopher C. Cheung, MDa,∗,
- Krystien V. Lieve, MDb,∗,
- Thomas M. Roston, MDa,
- Martijn H. van der Ree, MDb,
- Marc W. Deyell, MDa,
- Jason G. Andrade, MDa,
- Zachary W. Laksman, MDa,
- Eline A. Nannenberg, MD, PhDb,c,
- Rafik Tadros, MD, PhDb,
- Benjamin Pang, PhDd,
- Julie Rutberg, MSd,
- Martin S. Green, MDd,
- Susan Conacher, MSce,
- Colette M. Seifer, MDf,
- Jason D. Roberts, MD, MASf,
- Christian Steinberg, MDg,
- Shubhayan Sanatani, MDh,
- Arthur A. Wilde, MDb and
- Andrew D. Krahn, MDa,∗ ()
- aHeart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- bDepartment of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
- cDepartment of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- dDivision of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- eDivision of Cardiology, Western University, London Health Sciences Centre, London, Ontario, Canada
- fDivision of Cardiology, University of Manitoba, St. Boniface Hospital, Winnipeg, Manitoba, Canada
- gInstitut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
- hDivision of Cardiology, Department of Pediatrics, BC Children’s Hospital, Vancouver, British Columbia, Canada
- ↵∗Address for correspondence:
Dr. Andrew Krahn, Heart Rhythm Vancouver, 211-1033 Davie Street, Vancouver, BC V6E 1M7, Canada.
Objectives This investigation was a retrospective study of catecholaminergic polymorphic ventricular tachycardia (CPVT) patients in Canada and the Netherlands to compare pregnancy, postpartum, and nonpregnant event rates.
Background CPVT is characterized by life-threatening arrhythmias during exertion or emotional stress. The arrhythmic risk in CPVT patients during pregnancy is unknown.
Methods Baseline demographics, genetics, treatment, and pregnancy complications were reviewed. Event rate calculations assumed a 40-week pregnancy and 24-week postpartum period.
Results Ninety-six CPVT patients had 228 pregnancies (median 2 pregnancies per patient; range: 1 to 10; total: 175.4 pregnant patient-years). The median age of CPVT diagnosis was 40.7 years (range: 12 to 84 years), with a median follow-up of 2.9 years (range: 0 to 20 years; total 448.1 patient-years). Most patients had pregnancies before CPVT diagnosis (82%). Pregnancy and postpartum cardiac events included syncope (5%) and an aborted cardiac arrest (1%), which occurred in patients who were not taking beta-blockers. Other complications included miscarriages (13%) and intrauterine growth restriction (1 case). There were 6 cardiac events (6%) during the nonpregnant period. The pregnancy and postpartum event rates were 1.71 and 2.85 events per 100 patient-years, respectively, and the combined event rate during the pregnancy and postpartum period was 2.14 events per 100 patient-years. These rates were not different from the nonpregnant event rate (1.46 events per 100 patient-years).
Conclusions The combined pregnancy and postpartum arrhythmic risk in CPVT patients was not elevated compared with the nonpregnant period. Most patients had pregnancies before diagnosis, and all patients with events were not taking beta-blockers at the time of the event.
- cardiac arrest
- catecholaminergic polymorphic ventricular tachycardia
- sudden death
↵∗ Drs. Cheung and Lieve contributed equally to this paper and are joint first authors.
The study was supported by the Heart and Stroke Foundation of Canada (G-13-0002775 and G-14-0005732), and the Canadian Institute of Health Research (MOP-142218 and SRG-15-P09-001). Dr. Krahn is supported by the Heart and Stroke Foundation of Canada, the Sauder Family, Heart and Stroke Foundation Chair in Cardiology, the Paul Brunes Chair in Heart Rhythm Disorders, and The Paul Albrechtson Foundation. Drs. Wilde, Lieve, and Santani were supported by E-rare Improve CPVT. Drs. Wilde and Lieve were supported by CVON 2012-10 PREDICT. Dr. Roston has been a consultant for Audentes Therapeutics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received September 10, 2018.
- Revision received October 31, 2018.
- Accepted October 31, 2018.
- 2019 American College of Cardiology Foundation
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