Frequent premature ventricular contractions in pregnant patients are often considered benign, but this study found two cases of poor outcomes among 12 patients with over 1,000 PVCs in 24 hours. One patient developed ventricular tachycardia and cardiac arrest requiring a biventricular assist device. Another saw a decline in left ventricular function to 37% requiring multiple ablations, with a diagnosis of ectopy-induced cardiomyopathy. The study concludes that frequent PVCs in pregnancy should be further evaluated by specialists due to risks of underlying heart conditions.
Frequent premature ventricular contractions in pregnant patients are often considered benign, but this study found two cases of poor outcomes among 12 patients with over 1,000 PVCs in 24 hours. One patient developed ventricular tachycardia and cardiac arrest requiring a biventricular assist device. Another saw a decline in left ventricular function to 37% requiring multiple ablations, with a diagnosis of ectopy-induced cardiomyopathy. The study concludes that frequent PVCs in pregnancy should be further evaluated by specialists due to risks of underlying heart conditions.
Frequent premature ventricular contractions in pregnant patients are often considered benign, but this study found two cases of poor outcomes among 12 patients with over 1,000 PVCs in 24 hours. One patient developed ventricular tachycardia and cardiac arrest requiring a biventricular assist device. Another saw a decline in left ventricular function to 37% requiring multiple ablations, with a diagnosis of ectopy-induced cardiomyopathy. The study concludes that frequent PVCs in pregnancy should be further evaluated by specialists due to risks of underlying heart conditions.
Always Benign? Kristopher Knott1 and Amanda Varnava1,2 1. West Hertfordshire Hospitals NHS Trust, 2. Imperial College Healthcare NHS Foundation Trust Background and Methods • Premature ventricular contractions (PVC) in pregnancy are said to be benign in patients with structurally normal hearts despite a paucity of evidence. • In this retrospective observational study, the medical records of 12 patients with multiple PVCs (>1,000/24h) were looked at. Results • 12 patients were referred with PVCs ranging from 1,096 to 29,483 in 24 hours. • 11 out of 12 PVCs were monomorphic, 9 out of 12 captured on ECG. • The PVCs in 8 were of left bundle branch inferior axis, in 1 patient there were 2 distinct morphologies. • Initial left ventricular ejection fraction ranged from 55-87%. • Two patients had poor outcomes. Results Patient 1 • 28 year old presenting with PVCs in her 3rd trimester. • Background of idiopathic sinus tachycardia and anterior mitral valve prolapse. • 6,715 (4.6%) monomorphic PVCs, left bundle branch, inferior axis. • At 38 weeks she became hypertensive requiring emergency caesarean section and then suffered from ventricular tachycardia and PEA arrest. • Circulation was restored after 1 cycle of cardio-pulmonary resuscitation. • She required biventricular assist device implantation for severe cardiac failure • The diagnosis made was peripartum cardiomyopathy Figure 1. 24 hour ECG Patient 2
Figure 2a. 12 lead ECG
• 27 year old presenting asymptomatic in the 1st trimester. • Developed a gradual deterioration of left ventricular function, falling to 37% which persisted post partum. • Underwent caesarean section at 36 weeks gestation. • Ectopy continued to increase post partum requiring 2 catheter ablations (mid basal, lateral and mid RV wall). • Following the second ablation the LV function normalised but repolarisation abnormalities persist on the 12 lead ECG. • Diagnosis – tachycardia / ectopy induced cardiomyopathy Figure 2b. 24 hour ECG Conclusion • 10 of 12 patients with multiple PVCs proceeded to have uncomplicated deliveries and 2 had poor outcomes. • Multiple PVCs in pregnancy should be investigated with specialist assessment and investigation. • Possible mechanisms include ectopy heralding peripartum cardiomyopathy and an ectopy induced cardiomyopathy.