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Arrhythmic Mitral Valve Prolapse Risk During Pregnancy
Quick Takes
- Arrhythmogenic mitral valve prolapse is a rare condition.
- The perinatal period may pose an increased risk for arrhythmias in these patients, but the risk may be mitigated by continuation of antiarrhythmic therapy.
- Beta-blockers, flecainide, and other medications can be used in pregnancy.
Study Questions:
What are the characteristics of women with high-risk arrhythmic mitral valve prolapse (MVP) who developed malignant ventricular arrhythmias (VA) during the perinatal period? And is there an increased risk of malignant VA during pregnancy and the postpartum period?
Methods:
This was a case series of patients with arrhythmic MVP with at least one pregnancy and a history of malignant VA (defined as ventricular fibrillation, sustained ventricular tachycardia, or appropriate shock from an implantable cardioverter-defibrillator). The perinatal period was defined as during pregnancy and up to 6 months postpartum.
Results:
There were 18 women included from 11 centers with 7.5 (interquartile range, 5.8-16.6) years of follow-up. There were 37 episodes of malignant VA; of these, 18 occurred during pregnancy among 13 unique patients. Ten women were first diagnosed with arrhythmic MVP during the perinatal period due to malignant VA. Only 12 women were on antiarrhythmic medications including beta-blockers during pregnancy. The authors reported increased incidence of malignant VA during the perinatal period (pregnancy and up to 6 months postpartum) with univariate incidence rate ratio 2.66 (95% confidence interval, 1.23-5.76).
Conclusions:
The authors conclude that the perinatal period could impose an increased risk of malignant VA in women with known high-risk arrhythmic MVP.
Perspective:
MVP is a common diagnosis among young women of childbearing age. Additionally, palpitations and even syncope are common among pregnant patients; however, arrhythmogenic MVP remains a very rare diagnosis. This is evident as the authors contacted 27 large institutions and only 12 had data for the 18-patient cohort. While this study highlights the importance of properly identifying a higher-risk subset, the majority of pregnant patients with MVP will continue to benefit from reassurance.
If identified, patients with arrhythmogenic MVP should be monitored and treated. Beta-blockers, flecainide, and other medications are safe and effective during pregnancy. In this study, only one of eight women on flecainide treatment had malignant VA. Additionally, 10 women experienced their first arrhythmic episode during pregnancy, prior to starting medication. Therefore, when counseling a patient with arrhythmogenic MVP about the risks of pregnancy, the actual risk of arrhythmias will likely be lower than reported in this study, if the patient continues to receive appropriate antiarrhythmic therapy during pregnancy.
Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Prevention
Keywords: Arrhythmias, Cardiac, Mitral Valve Prolapse, Pregnancy, Cardio-Obstetrics
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