Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot

Q: What are the key findings of this study?

History of pregnancy was associated with a significantly higher prevalence of ventricular arrhythmias in women with repaired tetralogy of Fallot (age-adjusted OR 12.9, 95% CI 1.5-113.2, p=0.02).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Repaired tetralogy of Fallot (TOF) (n=80). Intervention: History of pregnancy vs. Nulliparity (no history of pregnancy). Primary outcome: Ventricular arrhythmia (non-sustained or sustained ventricular tachycardia, ventricular fibrillation, appropriate ICD therapy, or aborted cardiac arrest) (OR 12.9, 95% CI 1.5 to 113.2, p=0.02).

Q: What does this research mean for the field?

A history of pregnancy is associated with a significantly higher long-term prevalence of ventricular arrhythmias in women with repaired tetralogy of Fallot. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Alessia Quattrone; Øyvind Lie; Eirik Nestaas; Charlotte de Lange; Kirsti Try; Harald Lindberg; Helge Skulstad; Gunnar Erikssen; Thor Edvardsen; Kristina H. Haugaa; Mette E Estensen

doi:10.1136/openhrt-2020-001400

January 1, 2021Open HeartOpen Access

Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot

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Key result

Prior pregnancy linked to ~12.9-fold higher odds of ventricular arrhythmias in repaired TOF.

OR 12.9
95% CI 1.5 to 113.2
P=0.02
n=80

Figures

Why the study?

Patients with repaired tetralogy of Fallot often experience pregnancy, but the effects of pregnancy on long-term cardiovascular outcomes are not well known.

Does a history of pregnancy increase the risk of ventricular arrhythmias in women with surgically repaired tetralogy of Fallot?

Key Points

To assess the association between prior pregnancy, cardiac function, and the long-term occurrence of ventricular arrhythmias in women with repaired tetralogy of Fallot.
Recruited 80 women with repaired tetralogy of Fallot from a national registry database.
Assessed cardiac function and biomarkers using echocardiography and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) testing.
Detected ventricular arrhythmias (non-sustained or sustained ventricular tachycardia, or aborted cardiac arrest) using Holter monitoring or implanted devices.
Ventricular arrhythmias occurred in 21% (n=17) of participants, with a higher prevalence among women who had experienced pregnancy compared with nulliparous women (94% [n=16] vs 6% [n=1], p=0.02; age-adjusted OR 12.9, 95% CI 1.5 to 113.2, p=0.02).
Right ventricular mechanical dispersion was greater in patients with arrhythmias than those without (50±8 ms vs 39±14 ms, p=0.01; age-adjusted OR 2.1, 95% CI 1.3 to 7.5, p=0.01).
Serum NT-proBNP was higher in patients with arrhythmias (211 ng/L vs 139 ng/L, p=0.007), and NT-proBNP levels >321 ng/L identified women with arrhythmias independently of age (OR 7.2, 95% CI 1.7 to 30.1, p=0.007).

Study Design

Type

Cross-Sectional (n=80)

Multicenter

No

Structured PICO

Does a history of pregnancy increase the risk of ventricular arrhythmias in women with surgically repaired tetralogy of Fallot?

P

Population

80 adult women with surgically repaired tetralogy of Fallot (mean age 37 years, 69% with history of pregnancy at least 1 year prior) from a single-center registry in Norway.

E

Exposure

History of pregnancy (n=55, 69%; median parity 1, range 1–4; 19 with 1 child, 28 with 2 children, 8 with >2 children)

C

Comparator

Nulliparous women with repaired TOF (n=25, 31%; no history of pregnancy)

O

Outcome

Occurrence of clinically relevant ventricular arrhythmia (VA), composite of non-sustained ventricular tachycardia (NSVT, ≥3 consecutive beats >100 bpm for <30 s), sustained ventricular tachycardia (SVT, >30 s), ventricular fibrillation (VF), appropriate ICD therapy, or aborted cardiac arrest, assessed via ECG, 24-hour Holter monitoring, and ICD records.composite

Main Result

Odds Ratio: 12.9 (95% CI 1.5–113.2)

Absolute Event Rate: 29.1% vs 4%

p-value: p=0.02

Prior pregnancy, elevated NT-proBNP (>321 ng/L), and increased RV mechanical dispersion are age-independent markers associated with long-term ventricular arrhythmias in women with repaired tetralogy of Fallot, informing preconception counseling and risk stratification.

Limitations

Cross-sectional study design with retrospective adjudication of outcomes prevents causal inference
Small sample size at a relatively young age with only one event in the nulliparous group, leading to a wide confidence interval
Nulliparous women were significantly younger than mothers, making it difficult to completely separate the effects of age and parity
Lack of cardiac magnetic resonance (CMR) imaging data for volumetric assessment due to device contraindications and selection bias
Cross-sectional study with retrospective adjudication of outcome; cannot derive causal inference
Limited number of cases at a relatively young age
Only one patient had severe ventricular arrhythmias without prior pregnancy, resulting in a wide confidence interval
Nulliparous women were significantly younger than mothers, and age and parity cannot be separated completely despite statistical adjustment
Absence of cardiac MRI (CMR) data due to contraindications (implantable devices) and selection bias

Implication

Should not yet alter preconception counseling in repaired tetralogy of Fallot; hypothesis-generating association warrants prospective validation.

Abstract

OBJECTIVE: Patients with tetralogy of Fallot (TOF) have high survival rates 30 years after surgical repair. Many patients experience pregnancy; however, the effects of pregnancy on the long-term cardiovascular outcome are not well known. We investigated the association of pregnancy and cardiac function with occurrence of ventricular arrhythmia (VA) in women with TOF. METHODS: We recruited 80 women with repaired TOF from the national database. Holter monitoring or implanted devices detected VA, defined as non-sustained or sustained ventricular tachycardia or aborted cardiac arrest. All patients underwent echocardiography. Blood tests included NT-proBNP (N-terminal pro-brain natriuretic peptide). RESULTS: 55 (69%) women had experienced pregnancy. Mean age was lower in nulliparous compared with those with children (30±9 vs 40±9, p<0.01).VA had occurred in 17 (21%) women. Prevalence of VA was higher in women who had experienced pregnancy (n=16, 94%) compared with nulliparous (n=1, 6%) (p=0.02), also when adjusted for age (OR 12.9 (95% CI 1.5 to 113.2), p=0.02).Right ventricular mechanical dispersion was more pronounced in patients with VA (50±8 ms vs 39±14 ms, p=0.01, age-adjusted OR 2.1 (95% CI 1.3 to 7.5), p=0.01). NT-proBNP was also a marker of VA (211 ng/L (127 to 836) vs 139 ng/L (30 to 465), p=0.007). NT-proBNP >321 ng/L (normal values <170 ng/L) detected women with VA (p=0.019), also independent of age (OR 7.2 (95% CI 1.7 to 30.1), p=0.007). CONCLUSION: Pregnancy was associated with higher prevalence of VA among women with TOF. Right ventricular mechanical dispersion and NT-proBNP were age-independent markers of VA. These may have importance for pregnancy counselling and risk stratification.

Discussion

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Cite This Study

Quattrone et al. (2021) conducted a cross-sectional in Repaired tetralogy of Fallot (TOF) (n=80). History of pregnancy vs. Nulliparity (no history of pregnancy) was evaluated on Ventricular arrhythmia (non-sustained or sustained ventricular tachycardia, ventricular fibrillation, appropriate ICD therapy, or aborted cardiac arrest) (OR 12.9, 95% CI 1.5 to 113.2, p=0.02). History of pregnancy was associated with a significantly higher prevalence of ventricular arrhythmias in women with repaired tetralogy of Fallot (age-adjusted OR 12.9, 95% CI 1.5-113.2, p=0.02).

synapsesocial.com/papers/6a7348edd98d9ee37dc8fb9b https://doi.org/10.1136/openhrt-2020-001400

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Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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