Arrhythmia History Linked to Adverse Pregnancy Outcomes

The incidence of pregnancy-related complications was higher among a cohort of pregnant patients hospitalized for delivery who had a history of arrhythmias, and these negative outcomes were influenced by all-cause in-hospital mortality, cardiovascular disease, and adverse pregnancy outcomes.

Study findings published in Frontiers in Cardiovascular Medicine also show negative outcomes are more likely among this patient subgroup when they are older than 35 years, are classified as obese, and have hypertension, valvular heart disease, or severe pulmonary disease because they have a greater chance of also having a history of arrhythmias or a delivery-induced arrhythmia.

“Although many arrhythmias during pregnancy have been considered benign, there is also limited data suggesting a relationship with in-hospital death,” the study authors wrote. “There is also little data associating arrhythmias with comorbidities and risk factors.”

Data on delivery hospitalizations from 2009 to 2019 from the National Inpatient Sample (NIS) database were used for this analysis, and International Classification of Diseases, 9th Edition and 10th Edition codes identifying supraventricular tachycardias (SVT), atrial fibrillation (AF), atrial flutter, ventricular tachycardia (VT), and ventricular fibrillation. There were 41 million–plus delivery hospitalizations analyzed.

SVTs were the most common arrhythmia seen (53%), followed by AF (31%) and VT (13%). The authors determined several factors related a potential link between delivery complications and increased risk of arrhythmias, and these were the following:

• Valvular disease, which had an 11.77-times greater risk of leading to arrhythmias (odds ratio [OR], 12.77; 95% C1, 1.98-13.61)
• Heart failure, which had a 6.1-times greater associated risk (OR, 7.13; 95% CI, 6.49-7.83)
• Prior myocardial infarction (MI), 4.41-times greater risk (OR, 5.41; 95% CI, 4.01-7.30)
• Peripheral vascular disease (PVD), 2.19-times greater risk (OR, 3.19; 95% CI, 2.51-4.06)
• Hypertension, 1.18-times greater risk (OR, 2.18; 95% CI, 2.07-2.28)
• Obesity, 0.69-times greater risk (OR, 1.69; 95% CI, 1.63-1.76).

In addition, arrythmia-complicated hospital deliveries had higher rates of all-cause mortality, need for cardiogenic shock, preeclampsia, and preterm labor compared with women who did not have arrythmias (all P < .0001):

• All-cause in-hospital mortality: 0.95% vs 0.01%
• Need for cardiogenic shock: 0.48% vs 0.00%
• Preeclampsia: 6.96% vs 3.58%
• Preterm labor: 2.95% vs 2.41%

Delivery outcomes associated with arrythmias were also potential linked to older age, race/ethnicity, rural vs urban location, and insurance status:

• Women aged 31 to 35 years, 36 to 40 years, and 41 to 45 years were more likely to have adverse pregnancy outcomes if arrythmias were present vs those with no arrythmias: 26.58% vs 23.71%, 15.15% vs 10.86%, and 4.27% vs 2.07%, respectively
• White patients had the highest likelihood of adverse pregnancy outcomes accompanied by arrythmias vs those with no arrythmias (60.13% vs 52.82%) compared with Black patients who did or did not have arrythmias (20.44% vs 14.77%), Hispanic patients (11.35% vs 21.13%), and Asian patients (3.94% vs 5.76%)

Arrythmia-complicated deliveries vs women with no arrhythmias were also more than twice as likely if patients had these risk factors: obesity (16.95% vs 8.31%), hypertension (6.19% vs 1.53%), type 2 diabetes (1.39% vs 0.64%), MI history (0.22% vs 0.01%), PVD (0.23% vs 0.01%), and hyperlipidemia (0.35% vs 0.06%).

Risk behaviors were also more prevalent among the women with arrythmias, and these included tobacco use and substance abuse. Presence of comorbidities were also more common in women with arrhythmias, with the top 3 being chronic obstructive pulmonary disease, fluid and electrolyte disorders, and coagulopathy, respectively.

“These findings build upon previously published studies, which have all shown an increased frequency of arrhythmias in pregnant women since the 1990s. The measured rise in prevalence of arrhythmias during pregnancy is likely multifactorial,” the study authors wrote. “While the increased prevalence could be partially the result of a rise in risk factors, such an increase could be also be due to greater use of electronic medical records, remote monitoring, and overall shifts in monitoring and recording practices.”

They stressed the importance of multidisciplinary care and preventive cardiology prevention among women with known cardiovascular disease or who may be at higher risk for it, with cardio-obstetric care known to reduce cardiac maternal morbidity.

“Management of arrhythmia must occur at every stage of pregnancy,” they concluded, “from prevention to early recognition of complications during delivery.”

Reference

Thakkar A, Kwapong YA, Patel H, et al. Temporal trends of arrhythmias at delivery hospitalizations in the United States: Analysis from the National Inpatient Sample, 2009-2019. Front Cardiovasc Med. Published online November 3, 2022. doi:10.3389/fcvm.2022.1000298