Arrhythmias in Peripartum Cardiomyopathy

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Key points

  • Peripartum cardiomyopathy (PPCM) is a complication of late pregnancy and the early postpartum period characterized by dilated cardiomyopathy and heart failure with reduced ejection fraction.

  • Although the prevalence of specific arrhythmias in PPCM is unknown, an estimated 1 in 4 deaths in women with this condition is sudden and presumed secondary to ventricular tachyarrhythmia.

  • Management of PPCM entails standard treatment of heart failure with reduced ejection fraction and prevention of sudden

Arrhythmias in peripartum cardiomyopathy

Atrial and ventricular arrhythmias are common in patients with heart failure and cardiomyopathy.21 Data on arrhythmia associated specifically with PPCM are sparse, and underlying mechanisms are unclear (Fig. 3). Available data are limited to case reports and small case series, which are summarized in Table 1. In a series of 19 patients in Senegal with PPCM who underwent 24-hour continuous electrocardiographic monitoring, 89% had sinus tachycardia, 37% had premature ventricular contractions, 21%

Medical Management

Some women who develop arrhythmias secondary to PPCM may require intravenous antiarrhythmic drugs (AADs) in the acute setting or oral AADs for chronic management. In women requiring AADs prior to delivery, consideration must be given to the effects of AADs on fetal heart rhythm, fetal growth, and uterine activity.23

There is a dearth of data on the risk of AADs to the fetus in pregnancy. As a result, most AADs are Food and Drug Administration (FDA) pregnancy category C (risk cannot be ruled

Summary

Peripartum cardiomyopathy is a potentially life-threatening complication of pregnancy, occurring in the final month of gestation or up to 5 months postpartum. Management entails standard therapies for heart failure with reduced ejection fraction, with some exceptions in the antepartum period. Patients are at risk for arrhythmias and SCD. Much remains unknown about PPCM. In particular, further research is needed to elucidate the prevalence, underlying mechanism, and natural history of

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  • Cited by (0)

    The authors report no conflicts of interest.

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