Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp block, and other conditions may cause significant hemodynamic changes that greatly affect the mother and fetus, appropriate diagnosis and emergency treatment are commonly required. 12 Lead fracture, device-related thrombus and device infection are also problems. As the diaphragm elevates and the abdominal girth expands secondary to fetal growth, stress increases on the epicardial or transvenous system. In addition, the contractions associated with labor are intense enough to affect the muscles located in the upper torso and shoulder.Natale et al 5 reported their multicenter retrospective analysis of 44 women with an ICD who completed a pregnancy or were currently pregnant: 42 women had abdominally implanted generators, and 2 had a prepectoral device; 30 had epicardial lead sensing systems, and 14 had transvenous systems. In total, 36 (82%) experienced no complications, and 8 (18%) had a medical or device-related complication. The ICD-related problems included tenderness at the ICD pocket scar, generator migration, and pericarditis secondary to the epicardial patches. Medical complications were pulmonary embolism, worsening hyperthyroidism, congestive heart failure and weight loss. There were 37 vaginal deliveries and 7 cesarean sections; 39 babies were born healthy, 1 was stillborn, 2 were small for gestational age, 1 had transient hypoglycemia, and 1 woman had a therapeutic abortion unrelated to the ICD. During pregnancy, 33 women received no ICD therapy and the remaining 11 patients had shock discharges. The total number of shocks during pregnancy ranged from 0 to 11, with an average of 0.66±1.9 discharges. With regard to medications, 31 women had been on 1 or more antiarrhythmic drugs before becoming pregnant, 25 (56%) were on antiarrhythmic therapy and 19 took none during pregnancy. No lead fractures were reported. The authors of the study concluded that the mere presence of an ICD should not deter a woman from becoming pregnant unless she has an underlying structural cardiac disease that is considered a contraindication. Pregnancy does not increase the risk of major ICD-related complications or result in a high number of ICD discharges. That study is the largest clinical series reported on pregnancy outcomes in ICD recipients to date, but progress in the technology of ICD has been very rapid and the ICD devices are now outdated.In 2012, Schuler et al 6 reported a retrospective analysis of all women with an ICD who had pregnancy care provided by the specialist maternal cardiology service at University College London Hospitals. From a total of 580 pregnancies in women with heart disease, there were 19 pregnancies in 14 women with an ICD implant. During the antenatal period, device parameters remain unchanged from the non-pregnant state unless or young women with life-threatening arrhythmias, the use of an implantable cardioverter-defibrillator (ICD) enables them to reach their reproductive years. However, little ...
