P2533Prospective randomized study on implanted cardiac rhythm recorders in pregnant women with symptomatic arrhythmia and/or structural heart disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C A Viljoen ◽  
K Sliwa ◽  
F Azibani ◽  
M R Johnson ◽  
J Baard ◽  
...  
Keyword(s):  
At Risk ◽  
Heart Disease ◽  
Pregnant Women ◽  
Standard Care ◽  
Low Birthweight ◽  
Structural Heart Disease ◽  
Holter Monitoring ◽  
Study Groups ◽  
Direct Result ◽  
The Impact

Abstract Background Cardiac arrhythmia is an important cause of maternal morbidity and mortality in pregnancy, but is difficult to diagnose. Purpose The aim of this single-centre, prospective, randomized pilot study was to compare the implantable loop recorder (ILR) with standard assessment of arrhythmia (12-lead ECG; 24-hour Holter ECG) in terms of acceptability, detection of arrhythmias and impact on outcome in pregnant women with symptomatic arrhythmias and/or structural heart disease (SHD). Methods The study recruited 40 consecutive patients from a weekly, dedicated cardiac obstetric clinic. Inclusion criteria: symptoms of arrhythmia and/or having SHD at risk of arrhythmia. Patients were randomized to either standard care (SC) or standard care plus ILR (SC-ILR). ILR recordings were read at the monthly visits and/or when presenting with symptoms. Results There were no demographic differences between the study groups. Seventeen patients consented to ILR insertion, all of whom found the procedure acceptable. No arrhythmias were recorded by the 12-lead ECGs. Holter monitoring detected arrhythmias in 10 of 23 patients (43%) from the SC group. In the SC-ILR group, 8 of 17 patients (47%) had arrhythmias detected by Holter, whereas 13 of 17 patients (76%) patients had arrhythmias detected by ILR (p=0.157). One of 4 patients with supraventricular tachycardia, 2 of 3 patients with premature ventricular complexes and 2 patients with paroxysmal atrial fibrillation (AF) recorded by ILR did not have the arrhythmias detected by Holter monitoring (Figure 1A shows a scatter plot of the variable R-R intervals seen in AF and 1B a rhythm strip of AF with irregular RR intervals and the absence of P waves, both downloaded from the ILR). Four of these 5 patients (80%) had a change in management as a direct result of their ILR recordings. There were no maternal deaths up to 42 days postpartum in either of the study groups. Nine babies were born with a low birthweight (<2500g), 5 stillbirth/neonatal deaths and 1 pregnancy termination occurred (5 in the Holter group and 1 in ILR group, p=0.37). Figure 1 Conclusion(s) This study suggests that an ILR is an acceptable diagnostic modality in pregnant women with a suspected or at risk of arrhythmia. The ILR increased the diagnostic yield to detect arrhythmias that were not detected by routine ECG and Holter monitoring which led to a change in management in the SC-ILR group and was associated with better maternal and neonatal outcomes. The impact of ILR monitoring should be further assessed in larger studies with longer follow up.

scholarly journals Use of Routine Echocardiographic Screening for Structural Heart Disease in At-Risk Pregnant Women in India

2020 ◽  
Author(s):  
Amisha Patel ◽  
Lauren S. Ranard ◽  
Nicole Aranoff ◽  
Hussein Rahim ◽  
Roja Vanukuru ◽  
...  
Keyword(s):  
At Risk ◽  
Heart Disease ◽  
Pregnant Women ◽  
Structural Heart Disease ◽  
Women In India

scholarly journals P967 Profile of arrhythmia in pregnant women with different WHO class is similar

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Wisniowska-Smialek ◽  
A Lesniak-Sobelga ◽  
M Kostkiewicz ◽  
P Rubis ◽  
K Holcman ◽  
...  
Keyword(s):  
Heart Disease ◽  
Pregnant Women ◽  
Structural Heart Disease ◽  
Holter Monitoring ◽  
Cardiac Complications ◽  
P Value ◽  
Conduction Disturbances ◽  
Foetal Mortality ◽  
Group 2 ◽  
D 20

Abstract Background Arrhythmia is the most common cardiac complications during pregnancy especially in women with structural heart disease. Methods: Since January 2015 till December 2018 the consecutive 150 pregnant women with different maternal cardiovascular risk according to WHO classification: 100 in WHO I and II (gr 1);50 in WHO II-III, III, IV were enrolled. Each woman had 24-hour Holter- ECG monitoring during at least 2 trimester. Results: Except mild ventricular arrhythmia i.e ventricular extrasystole &gt; 1000 per 24 hour, which occured more often in group1, we did not observe any significant differences in arrhythmic profile of pregnant women with different WHO risk classification (table 1). Delivery: Caesarean section was more frequent in gr 2 (86% vs 62%) but rate of stillbirths were similar among groups. Maternal death did not occurred, there was 2 (4%) foetal mortality in gr 2. Mean duration of pregnancy, children length and birthweight were significantly higher in gr 1(table1).Conclusion: Arrhythmias during pregnancy occurred particularly on the substrate of structural heart disease. According to our observation pregnant women with potentially higher risk of maternal cardiovascular events did not reveal significant arrhythmia including conduction disturbances in comparison to women in WHO class I or II. Holter monitoring resultes Parameter Group 1; no 100 Group 2, no 50 P value Age 31(27-34) 31(28-33) 0,36 NYHA 1,34 1,32 0,76 SVE &gt; 1000/d 2(2,15%) 2(5,88%) 0,28 VE &gt; 1000/d 20(19,23%) 3(5,88%) 0,03 SVT 6(6,5%) 4(11,43%) 0,35 sVT 1(1%) 0 0,65 nsVT 8(8,79%) 3(8,57%) 0,96 AF/AT 0 2(4%) 0,54 AV I 5(5%) 3(6%) 0,32 AV II Mobitz I 1(1,1%) 1(2%) 0,53 AV III 0 1(2%) 0,41 Duration (weeks) 39(38-40) 37,1 0,017 Weight (grams) 3220+-641 2840+-767 g 0,02 Caesareon section 54(62%) 33(86%) 0,00 Stillbirths 22(21,57% 8(17,78%) 0,6

scholarly journals Preliminary Study of Coupling Intervals of Premature Ventricular Complexes in Dogs With Different Cardiac Diseases

2021 ◽  
Author(s):  
Liza Sally Koster ◽  
Jonathan Abbott
Keyword(s):  
Heart Disease ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Structural Heart Disease ◽  
Holter Monitoring ◽  
Antiarrhythmic Therapy ◽  
Premature Ventricular Complex ◽  
Coupling Interval ◽  
Familial Cardiomyopathy ◽  
Preliminary Study ◽  
Group 2

Abstract Coupling interval (CI), the time (ms) from the onset of a sinus QRS to the onset of the following premature ventricular complex (PVC), and their variability (CIV) might predict mortality and elucidate mechanisms of arrhythmogenesis. There has been limited investigation of CIV in dogs. Therefore, we determined CIV and prematurity index (PI) in three groups of dogs with ventricular arrhythmias that were subject to 24 hour ambulatory electrocardiographic (Holter) monitoring. Dogs in group 1 had presumptive arrhythmogenic right ventricular cardiomyopathy (ARVC), those in group 2 had structural heart disease in which patients with valvular heart disease predominated, and those in group 3 had a dilated cardiomyopathy (DCM) either phenotype or presumed familial cardiomyopathy. In this preliminary study, we did not find significant differences in indices of CIV between groups. Median PI was lower in dogs treated with antiarrhythmic therapy. Severity of cardiac remodeling, except for left atrial to aortic ratio, were not correlated with CIV. It was not possible to determine the mechanism of arrhythmias in ARVC, DCM phenotype or structural heart disease groups and re-entry, triggered activity, and abnormal automaticity are possible etiologies. The effect of antiarrhythmic therapy demonstrated potential drug effect on CIV. Risk for malignant arrhythmias and sudden cardiac death were not examined. A larger study would be needed to determine if differences exist; if present, this would give insight into possible mechanisms and optimal antiarrhythmic therapy.

Abstract 17499: Addition of Myocardial Parameters to the Diagnosis of Stage B Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Tom Marwick ◽  
Wojciech Kosmala ◽  
Christine Jellis
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Exercise Capacity ◽  
Beta Blockers ◽  
Cardiopulmonary Exercise Testing ◽  
Structural Heart Disease ◽  
Filling Pressure ◽  
Ischemic Heart

Introduction: Stage B heart failure (BHF, asymptomatic structural heart disease) is diagnosed in the presence of myocardial scar or impaired LVEF. However, the insensitivity of LVEF may lead to under-recognition of BHF in non-ischemic heart disease. This may be important, as BHF may precede the onset of HF symptoms, and necessitates the initiation of treatment. We sought the implications of using additional LV assessment to identify BHF in pts at risk of HF (stage A HF, AHF). Methods: We studied 510 asymptomatic pts (age 58±12yrs) with AHF (diabetes, hypertension or obesity), but no history of ischemic heart disease and a normal stress echo. All pts underwent echocardiography (including assessment of strain and diastolic dysfunction) and cardiopulmonary exercise testing. Results: BHF was defined as the presence of at least one of; reduced LV longitudinal strain (<18%), increased LV filling pressure (E/e’>13) or moderate-to-severe LV hypertrophy (LV mass index ≥109 g/m 2 in women and 132 g/m 2 in men) in 243 patients (47%). Reduced exercise capacity (peakVO 2 and METS) was identified in BHF compared with other AHF (Table). Using this definition, BHF was associated with lower peak VO 2 (β=-0.20, p<0.00001) and METS (β=-0.21, p<0.0001), independent of higher BMI, insulin resistance, older patient age, male sex and treatment with beta-blockers. Conclusions: LV hypertrophy, elevated LV filling pressure elevation and abnormal myocardial deformation independently contribute to lower exercise capacity in pts at risk of HF. Given the association of exercise capacity with outcome, these factors should be considered grounds for the diagnosis of BHF.

Sustained and non-sustained ventricular tachycardia and no associated heart disease (idiopathic ventricular tachycardia)

ESC CardioMed ◽  
2018 ◽  
pp. 2288-2293
Author(s):  
Victor Bazan ◽  
Enrique Rodriguez-Font ◽  
Francis E. Marchlinski
Keyword(s):  
Heart Disease ◽  
Ventricular Tachycardia ◽  
Drug Therapy ◽  
Catheter Ablation ◽  
Beta Blockers ◽  
Young Patients ◽  
Structural Heart Disease ◽  
Holter Monitoring ◽  
Severe Arrhythmia ◽  
The Right

Around 10% of ventricular arrhythmias (VA) occur in the absence of underlying structural heart disease. These so-called ‘idiopathic’ VAs usually have a benign clinical course. Only rarely do these “benign” arrhythmias trigger polymorphic ventricular tachycardia (PVT) and idiopathic ventricular fibrillation (VF). Due to their focal origin and to the absence of underlying myocardial scar, the 12-lead ECG very precisely establishes the right (RV) or left (LV) ventricular site of origin of the arrhythmia and can help regionalizing the origin of VT for ablation. A 12-lead ECG obtained during the baseline rhythm and 24-hour ECG Holter monitoring are indicated in order to identify structural or electrical disorders leading to PVT/VF and to determine the VA burden. The most frequent origin of idiopathic VAs is the RV outflow tract (OT). Other origins include the LVOT, the LV fascicles (fascicular VTs), the LV and RV papillary muscles, the crux cordis, the mitral and tricuspid annuli and the RV moderator band. Recognizing the typical anatomic sites of origin combined with a 12 lead ECG assessment facilitates localization.  Antiarrhythmic drug therapy (including use of beta-blockers) or catheter ablation may be indicated to suppress or eliminate idiopathic VAs, particularly upon severe arrhythmia-related symptoms or if the arrhythmia burden is high and ‘tachycardia’-induced cardiomyopathy is suspected. Catheter ablation is frequently preferred to prevent lifelong drug therapy in young patients.

scholarly journals Structural Heart Disease is Common Within a Community Cohort at Risk of Heart Failure—The SCREEN-HF Study

2013 ◽  
Vol 22 ◽  
pp. S88
Author(s):  
J. Coller ◽  
D. Campbell ◽  
H. Krum ◽  
L. Shiel ◽  
C. Reid ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Heart Disease ◽  
Structural Heart Disease

Clinical–Community Linkages: The Impact of Standard Care Processes that Engage Medicaid-Eligible Pregnant Women in Home Visiting

2021 ◽  
Author(s):  
Jennifer E. Raffo ◽  
Claire Titcombe ◽  
Susan Henning ◽  
Cristian I. Meghea ◽  
Kelly L. Strutz ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Standard Care ◽  
Home Visiting ◽  
Clinical Community ◽  
Care Processes ◽  
The Impact

scholarly journals Impact of antenatal counselling on couples’ knowledge and practice of contraception in Mansoura, Egypt

1999 ◽  
Vol 5 (5) ◽  
pp. 1002-1013
Author(s):  
M. H. Soliman
Keyword(s):  
Family Planning ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Study Groups ◽  
Study Group ◽  
Before And After ◽  
Joint Decisions ◽  
Knowledge And Practice ◽  
The Impact ◽  
Interview Questionnaire

The impact of antenatal counselling on couples’ knowledge and practice of contraception was investigated. An interview questionnaire was used before and after conducting counselling sessions with 200 pregnant women and 100 spouses. The participants were followed up immediately after delivery and 3 months later. Both the control and study groups displayed a lack of knowledge of contraception. Counselling sessions improved the couples’ knowledge and practice in the study group. Involving husbands in family planning counselling sessions led to joint decisions being made and encouraged women’s use of contraception. The majority of couples retained most of the information given. Integrating family planning counselling into antenatal care in all facilities and involving the husband are recommended

scholarly journals The burden of premature ventricular contractions predicts adverse fetal and neonatal outcomes among pregnant women without structural heart disease

2020 ◽  
Author(s):  
Jing Lin ◽  
Yanxia Qian ◽  
Xin Wu ◽  
Qiushi Chen ◽  
Qiang Ding ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Pregnant Women ◽  
Multivariate Logistic Regression Analysis ◽  
Structural Heart Disease ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Multivariate Logistic Regression ◽  
Premature Ventricular Contractions ◽  
The Impact

Abstract Objective: To investigate the outcomes of fetuses or neonates of pregnant women with premature ventricular contractions (PVCs). Study design: 6, 148 pregnant women were prospectively enrolled in the study. Of these women, 103 with a PVC burden >0.5% were divided into two groups based on the presence or absence of adverse fetal or neonatal events. The adverse outcomes were compared between the groups to assess the impact of PVCs on pregnancy. Results: A total of 17 adverse events (12 cases) occurred among 103 pregnant women with PVCs, which was significantly higher than that among women without PVCs (11.65% vs. 2.93%, p<0.01). The median PVC burden among pregnant women with PVCs was 2.84% (1.02% to 6.1%). Furthermore, compared with that of the women without adverse events, the median PVC burden of women with adverse fetal or neonatal outcomes was significantly higher (9.02% vs. 2.30%, p<0.01). Multivariate logistic regression analysis demonstrated that PVC burden was associated with adverse fetal or neonatal outcomes among pregnant women with PVCs (OR: 1.34, 95% CI (1.11-1.61), p<0.01). Conclusions: Frequent PVCs have adverse effects on pregnancy, and the PVC burden might be an important factor associated with adverse fetal and neonatal outcomes among pregnant women with PVCs. Our cohort study indicated that the higher the PVC burden is, the higher the likelihood of adverse events would be.

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