No ventricular arrhythmias in 522 deliveries in women with Brugada syndrome using conventional anaesthesia and analgesia

Background/Introduction Commonly used anaesthetic and analgesic methods during labour and delivery have been considered potentially pro-arrhythmic in Brugada syndrome (BrS), although supporting evidence is limited. Specific recommendations regarding analgesia and anaesthesia during pregnancy and labour in women with BrS are lacking. Purpose We aimed to assess the risk of ventricular arrhythmias during delivery in women with BrS and/or pathogenic or likely pathogenic (P/LP) SCN5A variants, with specific focus on exposure to anaesthetic and analgesic drugs, and to study arrhythmic events during pregnancy and up to 6 months postpartum. Methods This multicentre retrospective study included women with BrS and/or P/LP SCN5A variants at participating centres in Norway, The Netherlands, Sweden, and Switzerland with ≥1 delivery. Data on obstetric, anaesthetic and analgesic management were retrieved from medical records. Drugs were classified as drugs to be avoided and drugs to be used with caution in BrS according to prior evidence. Primary outcome was documented sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) during pregnancy or within 6 months postpartum. Results We studied 522 deliveries between 1964 and 2025 in 253 women. A total of 166 women (66%) had a clinical diagnosis of BrS, and 137 (54%) were SCN5A genotype positive. Only 20 (8%) women had received their diagnosis before their first delivery. Prior sustained VT/VF was documented in 11 women (4%) and 24 (9%) had an implantable cardioverter-defibrillator (ICD). Most deliveries were vaginal, with caesarean section (CS) rates comparable to national averages of 15-20%. We recorded 39 exposures to drugs classified as potentially pro-arrhythmic, of which 12 to be avoided and 29 to be used with caution (Figure). No pregnancy or peripartum sustained VT/VF were documented. Conclusion In this multicentre study, no sustained VT/VF occurred during pregnancy or within 6 months postpartum in 522 deliveries in women with BrS and/or SCN5A variants, using conventional obstetric, analgetic and anaesthetic management. Although limited by the retrospective design and the relatively low-risk phenotype of the cohort, the absence of arrhythmic events is reassuring for female BrS patients undergoing pregnancy and delivery.