Mobile Cardiac Telemetry Use to Predict Adverse Pregnancy Outcomes in Patients With Congenital Heart Disease

Carla P. Rodriguez; Katherine E. Economy; Valeria E. Duarte; Nishaki Mehta; Madeline E. Duncan; Stephanie Chandler; Kimberlee Gauvreau; Sarah Rae Easter; Fred Wu; Cara Lachtrupp; Usha Tedrow; Anne Marie Valente; Thomas Tadros

doi:10.1016/j.jacadv.2023.100593

Mobile Cardiac Telemetry Use to Predict Adverse Pregnancy Outcomes in Patients With Congenital Heart Disease

Carla P. Rodriguez^*, Katherine E. Economy, Valeria E. Duarte, Nishaki Mehta, Madeline E. Duncan, Stephanie Chandler, Kimberlee Gauvreau, Sarah Rae Easter, Fred Wu, Cara Lachtrupp, Usha Tedrow, Anne Marie Valente, Thomas Tadros

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Background: Patients with congenital heart disease (CHD) have a higher incidence of arrhythmias during pregnancy, yet the utility of mobile cardiac telemetry (MCT) to predict adverse outcomes is unknown. Objectives: The purpose of this study is to determine whether arrhythmias on screening MCT correlate with adverse pregnancy outcomes. Methods: Patients with CHD prospectively enrolled in the Standardized Outcomes in Reproductive Cardiovascular Care initiative underwent 24-hour MCT (within 18 months prior to pregnancy). Positive findings on MCT were defined as episodes of bradyarrhythmia, symptomatic atrioventricular block, ectopic atrial or ventricular activity, and supraventricular or ventricular tachycardia. Clinically significant arrhythmia events (CSAEs) were those requiring medical or device intervention or an emergency room visit. Clinical events during the antepartum, intrapartum, and postpartum periods were compared using Fisher's exact test. Analyses were performed using Stata version 16. Results: In 141 pregnancies in 118 patients with CHD, MCT detected positive findings in 17%. Adverse cardiac outcomes occurred in 11% of pregnancies, of which CSAE occurred in 3.5%. Positive MCT was significantly associated with subsequent CSAE (21% vs 0%, P < 0.001) and cumulative adverse maternal cardiac outcomes (33% vs 7%, P = 0.001) but did not correlate with obstetric (46% vs 41%, P = 0.660) or neonatal outcomes (33% vs 31%, P = 0.810). Of the patients with CSAE, 75% had ≥moderate CHD complexity. Conclusions: Patients with CHD had a high rate of positive MCT findings. This was associated with CSAE and adverse maternal cardiac outcomes. Patients with ≥moderate CHD complexity may benefit from screening MCT to improve preconceptual counseling and planning.

Original language	English (US)
Article number	100593
Journal	JACC: Advances
Volume	2
Issue number	8
DOIs	https://doi.org/10.1016/j.jacadv.2023.100593
State	Published - Oct 2023

Funding

The authors wish to acknowledge the other members of the STORCC team for contributing to the acquisition of data: Shivani R. Aggarwal, MBBS, MS1; Nael Aldweib, MD1; Laith Alshawabkeh, MD1; Nancy Barker, PA-C1; Yonatan Buber, MD1; Jean Marie Carabuena, MD2; Matthew Carazo, MD1; Emily Dollar, BS1; Sheila Drakeley, BS1; Valeria Duarte, MD1; Sarah Rae Easter, MD3; Gabriele Egidy Assenza, MD1; Julia Graf, BS1; Michelle Gurvitz, MD1; Daniel Halpern, MD1; Amy Harmon, PhD1; Kelsey Hickey, BS1; Jenna Hynes, MD1; Caitlyn Joyce, PA-C1; William P. Knapp, BS1; Michael Landzberg, MD1; Mary Mullen, MD1; Alexander Opotowsky, MD, MMSc1; Sara Partington, MD1; Saraubh Rajpal, MD1; Carrie Rouse, MD3; Zoe Schefter, BA1, Keri Shafer, MD1; Michael N. Singh, MD1; Ada C. Stefanescu Schmidt, MD, MSc1; Allison L. Tsao, MD1; and Shailendra Upadhyay, MD1. Affiliations: 1Department of Cardiology, Boston Children's Hospital; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 2Division of Obstetric Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA USA, 3Department of Obstetrics and Gynecology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA USA.

Keywords

ambulatory heart rhythm monitoring
arrhythmias
cardio-obstetrics
congenital heart disease
pregnancy

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Dentistry (miscellaneous)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jacadv.2023.100593

Cite this

Rodriguez, C. P., Economy, K. E., Duarte, V. E., Mehta, N., Duncan, M. E., Chandler, S., Gauvreau, K., Easter, S. R., Wu, F., Lachtrupp, C., Tedrow, U., Valente, A. M., & Tadros, T. (2023). Mobile Cardiac Telemetry Use to Predict Adverse Pregnancy Outcomes in Patients With Congenital Heart Disease. JACC: Advances, 2(8), Article 100593. https://doi.org/10.1016/j.jacadv.2023.100593

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title = "Mobile Cardiac Telemetry Use to Predict Adverse Pregnancy Outcomes in Patients With Congenital Heart Disease",

abstract = "Background: Patients with congenital heart disease (CHD) have a higher incidence of arrhythmias during pregnancy, yet the utility of mobile cardiac telemetry (MCT) to predict adverse outcomes is unknown. Objectives: The purpose of this study is to determine whether arrhythmias on screening MCT correlate with adverse pregnancy outcomes. Methods: Patients with CHD prospectively enrolled in the Standardized Outcomes in Reproductive Cardiovascular Care initiative underwent 24-hour MCT (within 18 months prior to pregnancy). Positive findings on MCT were defined as episodes of bradyarrhythmia, symptomatic atrioventricular block, ectopic atrial or ventricular activity, and supraventricular or ventricular tachycardia. Clinically significant arrhythmia events (CSAEs) were those requiring medical or device intervention or an emergency room visit. Clinical events during the antepartum, intrapartum, and postpartum periods were compared using Fisher's exact test. Analyses were performed using Stata version 16. Results: In 141 pregnancies in 118 patients with CHD, MCT detected positive findings in 17\%. Adverse cardiac outcomes occurred in 11\% of pregnancies, of which CSAE occurred in 3.5\%. Positive MCT was significantly associated with subsequent CSAE (21\% vs 0\%, P < 0.001) and cumulative adverse maternal cardiac outcomes (33\% vs 7\%, P = 0.001) but did not correlate with obstetric (46\% vs 41\%, P = 0.660) or neonatal outcomes (33\% vs 31\%, P = 0.810). Of the patients with CSAE, 75\% had ≥moderate CHD complexity. Conclusions: Patients with CHD had a high rate of positive MCT findings. This was associated with CSAE and adverse maternal cardiac outcomes. Patients with ≥moderate CHD complexity may benefit from screening MCT to improve preconceptual counseling and planning.",

keywords = "ambulatory heart rhythm monitoring, arrhythmias, cardio-obstetrics, congenital heart disease, pregnancy",

author = "Rodriguez, \{Carla P.\} and Economy, \{Katherine E.\} and Duarte, \{Valeria E.\} and Nishaki Mehta and Duncan, \{Madeline E.\} and Stephanie Chandler and Kimberlee Gauvreau and Easter, \{Sarah Rae\} and Fred Wu and Cara Lachtrupp and Usha Tedrow and Valente, \{Anne Marie\} and Thomas Tadros",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = oct,

doi = "10.1016/j.jacadv.2023.100593",

language = "English (US)",

volume = "2",

journal = "JACC: Advances",

issn = "2772-963X",

publisher = "Elsevier B.V.",

number = "8",

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TY - JOUR

T1 - Mobile Cardiac Telemetry Use to Predict Adverse Pregnancy Outcomes in Patients With Congenital Heart Disease

AU - Rodriguez, Carla P.

AU - Economy, Katherine E.

AU - Duarte, Valeria E.

AU - Mehta, Nishaki

AU - Duncan, Madeline E.

AU - Chandler, Stephanie

AU - Gauvreau, Kimberlee

AU - Easter, Sarah Rae

AU - Wu, Fred

AU - Lachtrupp, Cara

AU - Tedrow, Usha

AU - Valente, Anne Marie

AU - Tadros, Thomas

PY - 2023/10

Y1 - 2023/10

N2 - Background: Patients with congenital heart disease (CHD) have a higher incidence of arrhythmias during pregnancy, yet the utility of mobile cardiac telemetry (MCT) to predict adverse outcomes is unknown. Objectives: The purpose of this study is to determine whether arrhythmias on screening MCT correlate with adverse pregnancy outcomes. Methods: Patients with CHD prospectively enrolled in the Standardized Outcomes in Reproductive Cardiovascular Care initiative underwent 24-hour MCT (within 18 months prior to pregnancy). Positive findings on MCT were defined as episodes of bradyarrhythmia, symptomatic atrioventricular block, ectopic atrial or ventricular activity, and supraventricular or ventricular tachycardia. Clinically significant arrhythmia events (CSAEs) were those requiring medical or device intervention or an emergency room visit. Clinical events during the antepartum, intrapartum, and postpartum periods were compared using Fisher's exact test. Analyses were performed using Stata version 16. Results: In 141 pregnancies in 118 patients with CHD, MCT detected positive findings in 17%. Adverse cardiac outcomes occurred in 11% of pregnancies, of which CSAE occurred in 3.5%. Positive MCT was significantly associated with subsequent CSAE (21% vs 0%, P < 0.001) and cumulative adverse maternal cardiac outcomes (33% vs 7%, P = 0.001) but did not correlate with obstetric (46% vs 41%, P = 0.660) or neonatal outcomes (33% vs 31%, P = 0.810). Of the patients with CSAE, 75% had ≥moderate CHD complexity. Conclusions: Patients with CHD had a high rate of positive MCT findings. This was associated with CSAE and adverse maternal cardiac outcomes. Patients with ≥moderate CHD complexity may benefit from screening MCT to improve preconceptual counseling and planning.

AB - Background: Patients with congenital heart disease (CHD) have a higher incidence of arrhythmias during pregnancy, yet the utility of mobile cardiac telemetry (MCT) to predict adverse outcomes is unknown. Objectives: The purpose of this study is to determine whether arrhythmias on screening MCT correlate with adverse pregnancy outcomes. Methods: Patients with CHD prospectively enrolled in the Standardized Outcomes in Reproductive Cardiovascular Care initiative underwent 24-hour MCT (within 18 months prior to pregnancy). Positive findings on MCT were defined as episodes of bradyarrhythmia, symptomatic atrioventricular block, ectopic atrial or ventricular activity, and supraventricular or ventricular tachycardia. Clinically significant arrhythmia events (CSAEs) were those requiring medical or device intervention or an emergency room visit. Clinical events during the antepartum, intrapartum, and postpartum periods were compared using Fisher's exact test. Analyses were performed using Stata version 16. Results: In 141 pregnancies in 118 patients with CHD, MCT detected positive findings in 17%. Adverse cardiac outcomes occurred in 11% of pregnancies, of which CSAE occurred in 3.5%. Positive MCT was significantly associated with subsequent CSAE (21% vs 0%, P < 0.001) and cumulative adverse maternal cardiac outcomes (33% vs 7%, P = 0.001) but did not correlate with obstetric (46% vs 41%, P = 0.660) or neonatal outcomes (33% vs 31%, P = 0.810). Of the patients with CSAE, 75% had ≥moderate CHD complexity. Conclusions: Patients with CHD had a high rate of positive MCT findings. This was associated with CSAE and adverse maternal cardiac outcomes. Patients with ≥moderate CHD complexity may benefit from screening MCT to improve preconceptual counseling and planning.

KW - ambulatory heart rhythm monitoring

KW - arrhythmias

KW - cardio-obstetrics

KW - congenital heart disease

KW - pregnancy

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Mobile Cardiac Telemetry Use to Predict Adverse Pregnancy Outcomes in Patients With Congenital Heart Disease

Abstract

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Keywords

ASJC Scopus subject areas

UN SDGs

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