Management of Implantable Cardioverter-Defibrillators during Pregnancy—A Systematic Review

Abstract

Background: With the advent of implantable cardioverter-defibrillator (ICD) technology in recent decades, patients with inherited or congenital cardiomyopathy have a greater chance of survival into adulthood. Women with ICDs in this group are now more likely to reach reproductive age. However, pregnancy represents a challenge for clinicians, as no guidelines for the treatment of pregnant women with an ICD are currently available. Methods: To analyze this issue, we performed a systematic screening of the literature using the keywords: pregnancy with ICD, lead fracture in pregnancy, lead thrombi in pregnancy, ventricular tachycardia in pregnancy, inappropriate shocks in pregnancy, ICD discharge in pregnancy and ICD shock in pregnancy. Of 1101 publications found, 27 publications were eligible for further analysis (four retrospective trials and 23 case reports). Results: According to physiological changes in pregnancy, resulting in an increase in heart rate and cardiac output, a vulnerability for malignant arrhythmias and device-related complications in ICD carriers might be suspected. While the literature is limited on this issue, maternal complications including arrhythmia burden with following ICD therapies, thromboembolic events and lead complications as well as inappropriate shock therapy have been reported. According to the limited available studies, associated risk seems not to be more frequent than in the general population and depends on the underlying cardiac pathology. Furthermore, worsening of heart failure and related cardiovascular disease have been reported with associated risk of preterm delivery. These observations are exaggerated by restricted applications of diagnostics and treatment due to the risk of fetal harm in this population. Conclusions: Due to limited data on management of ICDs during pregnancy, further scientific investigations are required. Consequently, careful risk assessment with individual risk evaluation and close follow ups with interdisciplinary treatment are recommended in pregnant ICD carriers.

Usage of the wearable cardioverter-defibrillator during pregnancy

“…In addition, the influence of WCD shocks on the fetal outcome is unclear. In contrast, effectiveness and safety of ICD shocks in pregnancy were already shown in several studies [34] , [35] , [36] . These reports, found no increased risk for adverse fetal outcomes following the occurrence of ICD shocks [35] , [36] , [37] , [38] , [39] , [40] .…”

“…In contrast, effectiveness and safety of ICD shocks in pregnancy were already shown in several studies [34] , [35] , [36] . These reports, found no increased risk for adverse fetal outcomes following the occurrence of ICD shocks [35] , [36] , [37] , [38] , [39] , [40] . Similar results can be expected for WCD shocks, but further studies are necessary.…”

Is it safe to give birth with an activated implantable cardioverter–defibrillator: A multicentre observational study

“…Literature on pregnant women with an ICD in situ is limited. To date, four retrospective studies on this subject have been published, with a total of 76 included patients with an abdominal or TV‐ICD, 10,15–17 as well as one meta‐analysis 18 . In these studies, no inappropriate ICD shocks by these types of ICD were reported.…”