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Congenital heart disease
Original research
Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot
  1. Alessia Quattrone1,2,
  2. Oyvind H Lie1,2,
  3. Eirik Nestaas3,
  4. Charlotte de Lange4,5,
  5. Kirsti Try4,
  6. Harald L Lindberg6,
  7. Helge Skulstad1,2,
  8. Gunnar Erikssen1,
  9. Thor Edvardsen1,2,
  10. Kristina Haugaa1,2 and
  11. Mette E Estensen1,2
  1. 1Department of Cardiology, Oslo University Hospital, Oslo, Norway
  2. 2University of Oslo, Oslo, Norway
  3. 3Department of Paediatrics, Vestfold Hospital Trust, Tønsberg, Norway
  4. 4Division of Radiology and Nuclear Medicine, Section of Pediatric Radiology, Oslo University Hospital, Oslo, Norway
  5. 5Sahlgrenska University Hospital, Goteborg, Sweden
  6. 6Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Dr Mette E Estensen; mestense{at}ous-hf.no

Abstract

Objective Patients with tetralogy of Fallot (TOF) have high survival rates 30 years after surgical repair. Many patients experience pregnancy; however, the effects of pregnancy on the long-term cardiovascular outcome are not well known. We investigated the association of pregnancy and cardiac function with occurrence of ventricular arrhythmia (VA) in women with TOF.

Methods We recruited 80 women with repaired TOF from the national database. Holter monitoring or implanted devices detected VA, defined as non-sustained or sustained ventricular tachycardia or aborted cardiac arrest. All patients underwent echocardiography. Blood tests included NT-proBNP (N-terminal pro-brain natriuretic peptide).

Results 55 (69%) women had experienced pregnancy. Mean age was lower in nulliparous compared with those with children (30±9 vs 40±9, p<0.01).

VA had occurred in 17 (21%) women. Prevalence of VA was higher in women who had experienced pregnancy (n=16, 94%) compared with nulliparous (n=1, 6%) (p=0.02), also when adjusted for age (OR 12.9 (95% CI 1.5 to 113.2), p=0.02).

Right ventricular mechanical dispersion was more pronounced in patients with VA (50±8 ms vs 39±14 ms, p=0.01, age-adjusted OR 2.1 (95% CI 1.3 to 7.5), p=0.01). NT-proBNP was also a marker of VA (211 ng/L (127 to 836) vs 139 ng/L (30 to 465), p=0.007). NT-proBNP >321 ng/L (normal values <170 ng/L) detected women with VA (p=0.019), also independent of age (OR 7.2 (95% CI 1.7 to 30.1), p=0.007).

Conclusion Pregnancy was associated with higher prevalence of VA among women with TOF. Right ventricular mechanical dispersion and NT-proBNP were age-independent markers of VA. These may have importance for pregnancy counselling and risk stratification.

  • Fallots tetralogy
  • echocardiography
  • arrhythmias

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Researchers interested in the data, methods or analysis can contact the corresponding author for more information.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/openhrt-2020-001400

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplemental information. Researchers interested in the data, methods or analysis can contact the corresponding author for more information.

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    Footnotes

    • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included

    • Contributors AQ: acquired data, analysed data, performed statistical analysis, writing. OHL: analysed data, performed statistical analysis, made critical revision of the manuscript. EN: designed the study, made critical revision of the manuscript for important intellectual content. CdL: conceived and designed the study, made critical revision of the manuscript for important intellectual content. KT: acquired data, made critical revision of the manuscript for important intellectual content. HLL: conceived and designed the research, made critical revision of the manuscript for important intellectual content. HS: acquired data, made critical revision of the manuscript for important intellectual content. GE: acquired data, made critical revision of the manuscript for important intellectual content. TE: handling the funding, made critical revision of the manuscript. KHH: analysed data, performed statistical analysis, made critical revision of the manuscript. MEE: conceived and designed the research, made critical revision of the manuscript for important intellectual content, handling funding and supervision, writing.

    • Funding This study was supported by the South-Eastern Norway Regional Health Authority (NR 2017103).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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