Maternal cardiac arrhythmia in congenital heart disease: identifying high-risk pregnancy indicators.

Abstract

Background: The onset of arrhythmia during pregnancy has been noted as a significant issue in clinical management of adult congenital heart disease. The authors sought to examine the actual incidence of arrhythmias in CHD patients during pregnancy, as well as to distinguish prognostic predictors of arrhythmia in CHD pregnant patients, specifically focusing on the predictive value of echocardiographic parameters.

Methods: This retrospective study involved 244 pregnant patients with CHD in a tertiary hospital. Baseline characteristics and clinical presentation were systemically compared between the arrhythmia group and no arrhythmia group. Univariate analyses were performed to identify baseline characteristics and hemodynamic parameters associated with outcomes. Subsequent multivariate logistic regression model identified the adjusted odds ratio (aOR) and 95% CI to pinpoint the independent risk factors of arrhythmia in CHD pregnancy.

Results: The prevalence of arrhythmia in CHD patients during pregnancy was 17.6% (43/244). The arrhythmia group had more parity than the no arrhythmia group (0.72 vs 0.43, p = 0.010). Compared with the no arrhythmia group, the arrhythmia group's QRS duration was longer (105.1 ± 24.7 vs 93.6 ± 18.1 ms, p = 0.001). Patients with arrhythmia had both larger atrium size than patients without arrhythmia (right atrium: 51.0 ± 9.1 vs 47.4 ± 7.0 mm, p = 0.005; left atrium: 38.8 ± 7.6 vs 34.4 ± 4.8 mm, p = 0.000) respectively. Left ventricle end systolic volume in CHD patients with arrhythmia were considered larger than those without arrhythmia (29.9 ± 6.7 vs 27.7 ± 4.0 mm, p = 0.007), while not in left ventricle end diastolic volume (46.6 ± 9.2 vs 44.7 ± 5.2 mm, p = 0.067). The arrhythmia group were more likely to be presented with atrioventricular valve regurgitation (53.5% vs 15.4%, p = 0.000) than the no arrhythmia group. Multivariate logistic regression identified parity (aOR:1.895[95%CI: 1.033-3.478]), left atrium size (aOR:1.089[95%CI: 1.008-1.175]), and moderate atrioventricular valve regurgitation (aOR:3.317[95%CI: 1.272-8.647]) as independent contributors for arrhythmia during CHD pregnancy.

Conclusion: Early identification of risk factors that may predispose to arrhythmias favorably impacts long-term arrhythmia incidence and maternal neonatal outcome.