November 4, 1997Circulation
Implantable Cardioverter-Defibrillators and Pregnancy
Why the study?
Does the presence of an implantable cardioverter-defibrillator (ICD) increase the risk of complications or frequent discharges during pregnancy?
Population
44 pregnant women with implantable cardioverter-defibrillators (ICDs), mean age at initial implant 25.6 years.
Design
Cohort
Follow-up
mean 4.8+/-2.8 years after ICD implant
Authors
Discussion
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Implication
Low complication and discharge rates observed in pregnant women with ICDs; leaves open need for prospective confirmation before guiding practice.
Key Points
- To evaluate pregnancy outcomes, device-related complications, and the frequency of defibrillator discharges in women with implantable cardioverter-defibrillators (ICDs).
- Conducted a multicenter retrospective analysis of 44 women with an ICD who became pregnant, with a mean follow-up of 4.8 ± 2.8 years after device implantation.
- Assessed maternal baseline metrics (mean age 25.6 ± 4.9 years, ejection fraction 49.8 ± 9.7%), device configurations (42 abdominal and 2 prepectoral; 30 epicardial and 14 transvenous), delivery modes, and ICD discharges.
- Complications occurred in 18% (8/44) of patients, consisting of 4 device-related problems (scar tenderness, generator migration, pericarditis) and 5 medical issues (pulmonary embolism, congestive heart failure, worsening hyperthyroidism, weight loss, therapeutic abortion), while 82% (36/44) had no complications.
- Deliveries resulted in 37 vaginal births and 7 cesarean sections, with neonatal outcomes including 39 healthy infants, 1 stillbirth, 2 infants small for gestational age, and 1 case of transient hypoglycemia.
- No ICD therapy was delivered in 75% (33/44) of women during pregnancy, whereas 11 women received between 1 and 11 shocks (mean 0.66 ± 1.9 discharges per patient).
Structured PICO
Does the presence of an implantable cardioverter-defibrillator (ICD) increase the risk of complications or frequent discharges during pregnancy?
P
Population
44 pregnant women with implantable cardioverter-defibrillators (ICDs), mean age at initial implant 25.6 years.
I
Intervention
Pregnancy with an existing implantable cardioverter-defibrillator (ICD)
O
Outcome
Pregnancy outcomes, including maternal/fetal health, medical or device-related complications, and ICD therapies (shocks) during pregnancysafety
Pregnancy in women with an ICD is generally safe, with a low rate of major ICD-related complications and discharges, suggesting the presence of an ICD alone should not deter pregnancy.
Cite This Study
Natale et al. (1997) studied this question.