Atrial Fibrillation or Flutter During Pregnancy in Patients With Structural Heart Disease: Data From the ROPAC (Registry on Pregnancy and Cardiac Disease)

Amar M Salam; Ebru Ertekin; Iris M van Hagen; Jassim Al Suwaidi; Titia P E Ruys; Mark R Johnson; Lina Gumbiene; Alexandra A Frogoudaki; Khaled A Sorour; Laurence Iserin; Magalie Ladouceur; A Carla C van Oppen; Roger Hall; Jolien W Roos-Hesselink

doi:10.1016/j.jacep.2015.04.013

Atrial Fibrillation or Flutter During Pregnancy in Patients With Structural Heart Disease: Data From the ROPAC (Registry on Pregnancy and Cardiac Disease)

JACC Clin Electrophysiol. 2015 Aug;1(4):284-292. doi: 10.1016/j.jacep.2015.04.013. Epub 2015 Jun 22.

Affiliations

¹ Hamad Medical Corporation, Doha, Qatar.
² Erasmus Medical Center, Rotterdam, the Netherlands.
³ Imperial College School of Medicine, Chelsea and Westminster Hospital, London, United Kingdom.
⁴ Vilnius University Hospital Santariskiu Klinikos, Vilnius University, Vilnius, Lithuania.
⁵ Attikon University Hospital, Second Cardiology Department, Athens University, Athens, Greece.
⁶ Kasr AL-Aini Hospitals, Cairo University, Cairo, Egypt.
⁷ Necker Hospital and Georges Pompidou European Hospital, Assistance publique-Hôpitaux de Paris, Paris, France.
⁸ University Medical Center, Utrecht, the Netherlands.
⁹ Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
¹⁰ Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: j.roos@erasmusmc.nl.

PMID: 29759316
DOI: 10.1016/j.jacep.2015.04.013

Abstract

Objectives: Atrial fibrillation (AF)/atrial flutter (AFL) during pregnancy in these women is associated with adverse outcome of pregnancy.

Background: The incidence, timing, and consequences of AF or AFL during pregnancy in patients with heart disease are not well known.

Methods: Between January 2008 to June 2011, 60 hospitals in 28 countries prospectively enrolled 1,321 pregnant women with congenital heart disease, valvular heart disease, ischemic heart disease, or cardiomyopathy in the ROPAC (Registry of Pregnancy and Cardiac Disease). We studied the incidence, onset, and predictors of AF/AFL during pregnancy and assessed the pregnancy outcome. An overview of the existing literature is provided.

Results: Seventeen women (1.3%) developed AF/AFL during pregnancy, mainly in the second trimester (61.5%). Univariable analysis identified the following pre-pregnancy risk factors for AF/AFL in pregnancy: AF/AFL before pregnancy (odds ratio [OR]: 7.1, 95% confidence interval [CI]: 1.5 to 32.8); mitral valvular heart disease (OR: 6.9, 95% CI: 2.6 to 18.3); beta-blocker use (OR: 3.3, 95% CI: 1.2 to 9.0); and left-sided lesions (OR: 2.9, 95% CI: 1.0 to 8.3). Maternal mortality was higher in women with than in women without AF/AFL (11.8% vs. 0.9%; p = 0.01), although heart failure was not seen more often. Low birth weight (<2,500 g) occurred more often in women with than in women without AF/AFL (35% vs. 14%; p = 0.02).

Conclusions: AF/AFL occurs in 1.3% of pregnant patients with structural heart disease with a peak at the end of the second trimester. AF/AFL during pregnancy in cardiac patients is associated with unfavorable maternal outcome and also has an impact on fetal birth weight.

Keywords: adult congenital heart disease; atrial fibrillation; atrial flutter; pregnancy and heart disease; valvular heart disease.