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Electrocardiographic Changes in Pregnant Patients With Congenital Heart Disease
Maria A Pabon1, Amrit Misra1,2,3, Kimberlee Gauvreau2
1Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Insights
Pregnant patients with congenital heart disease (CHD) experience EKG changes during pregnancy, including heart rate and QTc interval variations. These electrocardiogram (EKG) findings generally remain within normal limits and return to baseline postpartum.
Area of Science:
- Cardiology
- Maternal-Fetal Medicine
- Congenital Heart Disease
Background:
- Electrocardiograms (EKGs) are standard for pregnant individuals with pre-existing cardiovascular disease.
- EKG alterations during pregnancy in patients with congenital heart disease (CHD) remain under-explored.
Purpose of the Study:
- To investigate EKG changes throughout gestation in pregnant patients with various types of CHD.
- To compare EKG parameters across different CHD subtypes during pregnancy.
Main Methods:
- Retrospective analysis of pregnant patients with CHD from the STORCC initiative.
- Inclusion criteria: at least two EKGs per patient across the perinatal period.
- EKG parameters analyzed by blinded investigators in patients with atrial septal defect, tetralogy of Fallot, pulmonary stenosis, coarctation of the aorta, bicuspid aortic valve, systemic right ventricle, and Fontan circulation.
Main Results:
- 170 pregnant patients with CHD were included.
- Heart rate (HR) increased significantly from pre-pregnancy to the third trimester in most groups, excluding Fontan and systemic right ventricle (SRV) circulations.
- Statistically significant increases in QTc duration were observed in atrial septal defect (ASD) and bicuspid aortic valve (BAV) groups.
- QRS duration shortened in the third trimester for ASD and coarctation of the aorta (CoA) patients.
- All EKG parameters remained within normal physiological limits and normalized postpartum.
Conclusions:
- Pregnant patients with CHD exhibit significant EKG changes during gestation.
- These electrocardiogram (EKG) alterations, including heart rate and QTc interval, typically stay within normal ranges.
- Individuals with SRV and Fontan circulation may not demonstrate the typical physiological heart rate increase during pregnancy.
Background:
Electrocardiograms (EKGs) are routinely performed in pregnant patients with pre-existing cardiovascular disease. However, in pregnant patients with congenital heart disease (CHD), EKG changes during gestation have not been explored.
Methods:
We performed a retrospective study of pregnant patients with CHD enrolled in the STORCC initiative. Patients were included if they had at least two EKGs across the perinatal period and were grouped by specific conditions: atrial septal defect (ASD), tetralogy of Fallot, congenital pulmonary stenosis, coarctation of the aorta (CoA), bicuspid aortic valve (BAV), systemic right ventricle (SRV), and Fontan circulation. EKG parameters were measured in all available EKGs by two investigators, blinded to diagnosis and time of gestation.
Results:
One hundred and seventy pregnant patients were included. There was a statistically significant increase in HR from pre-pregnancy to third trimester in all groups except for those with Fontan and SRV. Patients with ASD and BAV had a statistically significant increase in their QTc (ASD:13 ms, p = 0.017; BAV:7 ms, p = 0.018) during pregnancy. QRS duration was shorter (4 ms) in the third trimester for patients with ASD (p = 0.033) and CoA (p = 0.014). Despite these individual findings, EKG parameters remained within normal limits and regressed to baseline in the postpartum period.
Conclusions:
Patients with CHD have statistically significant EKG changes throughout pregnancy, but the values remain within normal limits. Like patients without heart disease, those with CHD increase their HR during pregnancy, except individuals with SRV and Fontan, who appear to lack capacity for physiologic HR augmentation.
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