Risk for life-threatening arrhythmia in newly diagnosed peripartum cardiomyopathy with low ejection fraction: a German multi-centre analysis

Abstract

IntroductionPeripartum cardiomyopathy (PPCM) is a rare cardiomyopathy characterized by an acute reduction in left ventricular ejection fraction (LVEF). Sudden deaths during the course of PPCM are reported to be elevated, the underlying mechanisms remains unknown. The aim of the present multi-centre study was to evaluate the arrhythmia burden in a multi-centre approach in patients with PPCM using a wearable cardioverter/defibrillator (WCD).Methods and resultsForty-nine patients from 16 German centres with newly diagnosed PPCM and LVEF ≤35% receiving a WCD were included in this retrospective analysis. Mean follow-up was 15 ± 10 months. At diagnosis, mean age was 33 ± 5 years, parity was 2.1 ± 1.6, LVEF was 21 ± 7%, NYHA functional class was 3.4 ± 0.7. Mean wear time was 120 ± 106 days, mean wear time per day was 21.4 ± 3.3 h. Six (12%) patients presented eight ventricular tachyarrhythmias during WCD period: five episodes of VF, two sustained ventricular tachycardia (VT) and one non-sustained VT occurred.ConclusionThis multicentre study underpins the elevated risk for ventricular tachyarrhythmias in patients with newly diagnosed PPCM and reduced LVEF. A WCD should be considered for 3–6 months in these patients to prevent sudden cardiac death from ventricular tachyarrhythmias.

First experience with zero-fluoroscopic ablation for supraventricular tachycardias using a novel impedance and magnetic-field-based mapping system

“…Given these well-recognized hazards, it is vitally important that zero- or near-zero-fluoroscopic approaches in EP are explored and refined, to minimise risks. These are especially important in high-risk populations, including children, pregnant women, and women with child-bearing potential [18, 19]. …”

Peripartum cardiomyopathy

“…In the US between 2004 and 2011, 2.1% of women with PPCM had a cardiac arrest, and 2.9% underwent implantation of a cardiac device 12. In a German series of 49 women with PPCM and LVEF, ≤35% of whom used wearable cardioverter defibrillators for 120 days, six patients experienced ventricular tachyarrhythmias; these arrhythmias included five episodes of ventricular fibrillation, two episodes of sustained ventricular tachycardia, and one episode of non-sustained ventricular tachycardia 112. An analysis of 9841 hospital admissions for PPCM in the US found that arrhythmias occurred in 18.7% of cases, with ventricular tachycardia occurring in 4.2% 113…”

Peripartum cardiomyopathy

“…In a German retrospective analysis, a remarkably high number of six out of 49 PPCM patients (12%) suffered from life-threatening arrhythmia [37]. Most of the PPCM patients fully recover or at least improve significantly within 3–6 months and the risk of malignant arrhythmia thereby decreases.…”

“…Hence, immediate implantation of a permanent cardioverter/defibrillator (ICD) does not appear to be appropriate. Instead, the use of a wearable cardioverter/defibrillator (WCD; LifeVest®, Zoll, Pittsburgh, PA, USA) is recommended to prevent SCD [7, 29, 37]. In patients who do not recover LV function (LVEF ≤35%) despite optimal medical therapy or those who experience ventricular tachycardia with hemodynamic instability or ventricular fibrillation, implantation of an ICD (either transvenous or subcutaneous) or a cardiac resynchronization device defibrillator (CRT-D) is recommended according to current guidelines [29].…”