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Objective: The goal of this study was to investigate whether pre-existing cardiac arrhythmias are associated with adverse obstetrical outcomes in women with a history of open cardiac surgery. Study Design: This was a retrospective cohort study of women with a history of open cardiac surgery who delivered at MedStar Washington Hospital Center (Washington, DC) from January 2007 through December 2018. Women with isolated percutaneous cardiac surgical repair were excluded. Maternal and neonatal outcomes were compared between patients with pre-existing cardiac arrhythmias and patients without pre-existing cardiac arrythmias. Maternal outcomes studied were intensive care unit (ICU) admission, postpartum blood loss greater than 1000 mL, congestive heart failure (CHF) development, pre-eclampsia with severe features, postpartum readmission, postpartum cardiac events, and postpartum length of stay >5 days. Neonatal outcomes investigated were low birth weight <2500g, Apgar scores <7 at 5 minutes, and neonatal intensive care unit (NICU) admission. Multivariate logistic regression model was used calculate adjusted odds ratio (aOR) and 95% confidence intervals (95% CI). Results: The outcomes for sixety-nine deliveries from fifty-six women with a history of open cardiac surgery were examined. Thirty-three women (48%) had arrhythmias after cardiac surgery with fourteen (20%) requiring Implantable Cardiac Defibrillators (ICDs). Two women (6%) with pre-existing arrhythmias after cardiac surgery developed postpartum volume overload requiring readmission (p=0.06). After controlling for age, gestational age at delivery and BMI, pre-eclampsia with severe features (p=0.02) and low birth weight neonates (p=0.02, aOR 2.26 (0.56-9.03)) remained statistically more like to occur in patients with pre-existing cardiac arrythmias than in patients without pre-existing arrhythmias. Conclusion: Women with a history of open cardiac surgery and pre-existing cardiac arrhythmias prior to pregnancy are more likely to develop pre-eclampsia with severe features and have low birth weight neonates compared to women with a history of open cardiac surgery without pre-existing cardiac arrhythmias.

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