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Cited by 79Cardiovascular Issues in PregnancyAtrial Fibrillation Management and OutcomesCardiovascular and Diving-Related Complications

Atrial Fibrillation or Flutter During Pregnancy in Patients With Structural Heart Disease

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Salam, Amar M., Ertekin, Ebru, van Hagen, Iris M., Al Suwaidi, Jassim, Ruys, Titia P.E., Johnson, Mark R., Gumbiene, Lina, Frogoudaki, Alexandra A. +6 more·2015·JACC. Clinical electrophysiology
DOI 10.1016/j.jacep.2015.04.013
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Abstract

Objectives Atrial fibrillation (AF)/atrial flutter (AFL) during pregnancy in these women is associated with adverse outcome of pregnancy.Background The incidence, timing, and consequences of AF or AFL during pregnancy in patients with heart disease are not well known.Methods Between January 2008 to June 2011, 60 hospitals in 28 countries prospectively enrolled 1,321 pregnant women with congenital heart disease, valvular heart disease, ischemic heart disease, or cardiomyopathy in the ROPAC (Registry of Pregnancy and Cardiac Disease). We studied the incidence, onset, and predictors of AF/AFL during pregnancy and assessed the pregnancy outcome. An overview of the existing literature is provided.Results Seventeen women (1.3%) developed AF/AFL during pregnancy, mainly in the second trimester (61.5%). Univariable analysis identified the following pre-pregnancy risk factors for AF/AFL in pregnancy: AF/AFL before pregnancy (odds ratio [OR]: 7.1, 95% confidence interval [CI]: 1.5 to 32.8); mitral valvular heart disease (OR: 6.9, 95% CI: 2.6 to 18.3); beta-blocker use (OR: 3.3, 95% CI: 1.2 to 9.0); and left-sided lesions (OR: 2.9, 95% CI: 1.0 to 8.3). Maternal mortality was higher in women with than in women without AF/AFL (11.8% vs. 0.9%; p = 0.01), although heart failure was not seen more often. Low birth weight (<2,500 g) occurred more often in women with than in women without AF/AFL (35% vs. 14%; p = 0.02).Conclusions AF/AFL occurs in 1.3% of pregnant patients with structural heart disease with a peak at the end of the second trimester. AF/AFL during pregnancy in cardiac patients is associated with unfavorable maternal outcome and also has an impact on fetal birth weight.

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Authors
Salam, A. M., Ertekin, E., van Hagen, I. M., Al Suwaidi, J., Ruys, T. P. E., Johnson, M. R., Gumbiene, L., Frogoudaki, A. A., Sorour, K. A., Iserin, L., Ladouceur, M., van Oppen, A. C. C., Hall, R., & Roos-Hesselink, J. W.
Affiliations
  • Hamad Medical Corporation (QA)
  • Erasmus MC (NL)
  • Chelsea and Westminster Hospital (GB)
  • National and Kapodistrian University of Athens (GR)
  • Cairo University (EG)
  • Hôpital Necker-Enfants Malades (FR)
  • University of East Anglia (GB)
ORCID
Venue
JACC. Clinical electrophysiology
Publisher
Elsevier BV
Published
2015-08
Volume
1
Issue
4
Pages
284-292
ISSN
2405-500X (ISSN-L)
DOI
10.1016/j.jacep.2015.04.013
OpenAlex
W1466377165
Cited by
79
References
27
Citations by year
2026: 10 · 2025: 8 · 2024: 9 · 2023: 8 · 2022: 7 · 2021: 8 · 2020: 8 · 2019: 3 · 2018: 3 · 2017: 6 · 2016: 8 · 2015: 1
FWCI
4.40
Type
journal article
Language
en
Open access
Licence
Locations
  • JACC. Clinical electrophysiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Boehringer Ingelheim
  • Amgen
  • Daiichi-Sankyo
  • Bristol-Myers Squibb
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Issues in Pregnancy
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
Keywords
atrial fibrillation, atrial flutter, pregnancy, structural heart disease, congenital heart disease, valvular heart disease, ischemic heart disease, cardiomyopathy, maternal mortality, low birth weight, beta-blocker use, mitral valve disease, pregnancy outcomes

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