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
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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.
Patient consent for publication Not required.
Ethics approval The study was carried out according to the principles of the Declaration of Helsinki. This protocol was approved by the Regional Committees for Medical Research Ethics South East D (REK sør-øst D, reference number 2017/383) and the Oslo University Hospital Information Security and Privacy Office (number 19/09499).
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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