Efficacy and Safety of Implantable Cardioverter-Defibrillator Use in Peripartum Cardiomyopathy

Implantable cardioverter-defibrillators (ICDs) are recommended in various forms of heart failure, but little is known about outcomes in peripartum cardiomyopathy (PPCM).

The authors compared long-term ICD-related outcomes in patients with PPCM vs non-PPCM nonischemic cardiomyopathy (NICM).

Patients with PPCM and a control group of ethnicity-matched non-PPCM patients, with ICD implantation between 1996 and 2016 were identified. Device interrogation records were reviewed through 2018. Device therapy (shocks, antitachycardia pacing), device-related complications, and outcomes were analyzed.

Of 150 patients with PPCM, 20% (N = 30) underwent ICD implantation at median time from diagnosis of 7 months (IQR: 15 months) and left ventricular ejection fraction of 18% (IQR: 18%). Over 8 ± 6 years of ICD use (mean), 43% received appropriate device therapy (shock and/or antitachycardia pacing), similar to the NICM control group. Inappropriate device therapy occurred in 30% of patients with PPCM, most commonly due to supraventricular tachycardia. One-third of patients required at least one subsequent invasive ICD-related procedure other than generator replacement. After ICD implantation, 9 patients with PPCM (30%) had subsequent improvement of left ventricular ejection fraction to >50% and 4 of them had received appropriate ICD therapy. In comparison to the control group, there were no statistically significant differences in device therapy, despite longer ICD follow-up in the NICM control group (median 12 months vs 5 months, respectively, P < 0.05).

In this cohort of patients with PPCM and ICD, rates of appropriate device therapy were high. Over long-term follow-up, rates of inappropriate shocks and device complications were also substantial in both PPCM and NICM cohorts.