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Pregnancy in women with congenital heart disease: the value of routine 24-hour electrocardiography for detection of arrhythmia.

Keywords:
arrhythmia pregnancy congenital heart disease

Researchers:
Dr. P.G. Pieper
A.S. Siegmund

Nature of the research:
Clinical research

Fields of study:
cardiology

Background / introduction
Due to improvement in cardiothoracic surgery, most of the patients with congenital heart disease survive until adulthood and the majority of women with congenital heart disease pursue pregnancy.
Pregnancy causes various hemodynamic changes, including a rise in circulating volume and heart rate as well as a decrease in blood pressure. These changes can have deleterious effects on the heart of women with congenital heart disease.
Cardiac complications during pregnancy in women with congenital heart disease are common and several risk factors have been identified (1-4). Most of the complications observed are arrhythmias. The ESC guidelines on the management of cardiovascular disease during pregnancy recommend performing holter monitoring in patients with known previous paroxysmal of persistent documented arrhythmia or those reporting symptoms of palpitations(5). Palpitations actually occur frequently during pregnancy and are a common indication for cardiac evaluation.
There are no data on the value of performing routine holter monitoring during pregnancy in women with congenital heart disease, irrespective of the cardiac history. In the Dutch ZAHARA studies routine holter monitoring was performed in women with congenital heart disease at 20 and 32 weeks of pregnancy.
Research question / problem definition
The aim of this study is to evaluate the yield of standard performing holter monitoring in pregnant women with congenital heart disease, irrespective of cardiac history of arrhythmias.
The secondary objective of this study is to determine clinical parameters associated with the yield of standard holter monitoring during pregnancy in women with congenital heart disease.
References
1. Drenthen W, Pieper PG, Roos-Hesselink JW, et al. Outcome of pregnancy in women with congenital heart disease: A literature review. J Am Coll Cardiol. 2007;49:2303-11.
2. Drenthen W, Boersma E, Balci A, et al. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J. 2010;31:2124-32.
3. Siu SC, Sermer M, Colman JM, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104:515-21.
4. Khairy P, Ouyang DW, Fernandes SM, et al. Pregnancy outcomes in women with congenital heart disease. Circulation. 2006;113:517-24.
5. European Society of Gynecology, Association for European Paediatric Cardiology, German Society for Gender Medicine, et al. ESC guidelines on the management of cardiovascular diseases during pregnancy: The task force on the management of cardiovascular diseases during pregnancy of the european society of cardiology (ESC). Eur Heart J. 2011;32:3147-97.
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