Implantable Cardioverter-Defibrillators in Pregnant Individuals

BACKGROUND: Evidence-based guidance for pregnancy management in patients with implantable cardioverter-defibrillators (ICDs) includes careful multidisciplinary antepartum and delivery planning. METHODS: Case series describing outcomes of 23 pregnancies among 9 patients with arrhythmias and ICDs. RESULTS: Among the 9 patients all 23 pregnancies were carried to term, 13 of which were managed by our cardio-obstetrics program from March 2010 to October 2025. Median delivery gestational age was 39.3 weeks. Primary cesarean delivery rate was 55.5%, with cesareans performed for obstetric indications. Three pregnancies experienced cardiac complications: antepartum ventricular tachycardia, postpartum atrial fibrillation, and postpartum heart failure. No patients experienced inappropriate firings or device complications. CONCLUSIONS: Most patients in our case series experienced excellent perinatal and cardiac outcomes, with a maternal cardiac event rate of 13.0%. Our case series highlights the crucial role of coordinated multidisciplinary care, including antiarrhythmic therapy, fetal surveillance, labor and delivery planning, and close follow-up during the postpartum period.