title: Pregnancy in women with an implantable cardioverter-defibrillator: is it safe?
abstract: OBJECTIVE
  To describe obstetric/neonatal and cardiac outcomes for a cohort of women carrying implantable cardioverter-defibrillators (ICDs) during pregnancy.
  
  
  RESULTS
  All women in routine follow-up at our institution for ICD implantation who became pregnant between 2006 and 2013 were included in this study. All ICDs were pre-pectoral devices with bipolar endocardial leads. Obstetric/neonatal and cardiac outcomes were assessed during pregnancy and post-partum. Twenty pregnancies were conceived by 12 women carrying ICD devices, 14 of which resulted in live births and none in maternal death. Seven of these women had structural cardiomyopathies and five had channelopathies. No device-related complications were recorded. Twelve shocks (nine transthoracic and three from ICDs) were experienced during pregnancy by two women, one of whom miscarried shortly afterwards at 4 weeks gestation. One stillbirth, three miscarriages and one termination were recorded for women with long QT syndrome, repaired tetralogy of Fallot and repaired Laubry-Pezzi syndrome, respectively. Intrauterine growth restriction, low birth weight, and neonatal hypoglycaemia were recorded in four, three, and five pregnancies, respectively.
  
  
  CONCLUSIONS
  Pregnancy had no effect on ICD operation and no evidence was found to link ICD carriage with adverse pregnancy outcomes, although one miscarriage may have been induced by ICD shock therapy. A worsening of cardiac condition occurs in specific cardiac diseases and β-blocker therapy should be continued for all women carrying ICDs in pregnancy as the benefits outweigh the risks of taking this medication.
authors.affiliation: Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France stephane.boule@chru-lille.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Boulé
authors.affiliation: Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Ovart
authors.affiliation: Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Marquié
authors.affiliation: Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France.
authors.forename: Edward
authors.initials: E
authors.lastname: Botcherby
authors.affiliation: Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France Faculty of medicine, University of Lille 2, 59045 Lille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.affiliation: Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Kouakam
authors.affiliation: Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Brigadeau
authors.affiliation: Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Guédon-Moreau
authors.affiliation: Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France Faculty of medicine, University of Lille 2, 59045 Lille, France.
authors.forename: Ludivine
authors.initials: L
authors.lastname: Wissocque
authors.affiliation: Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Meurice
authors.affiliation: Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France Faculty of medicine, University of Lille 2, 59045 Lille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Lacroix
authors.affiliation: Department of Cardiovascular medicine, Lille University Hospital, Hôpital Cardiologique, CHRU, 59037 Lille, France Faculty of medicine, University of Lille 2, 59045 Lille, France.
authors.forename: Salem
authors.initials: S
authors.lastname: Kacet
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D009202:Cardiomyopathies / Q000151:congenital / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017147:Defibrillators, Implantable; D018450:Disease Progression; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D004562:Electrocardiography; D005260:Female; D005602:France; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D050498:Live Birth; D061214:Patient Safety; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Arrhythmia; Cardioversion; Implantable cardioverter-defibrillator; Pregnancy; Shock; Ventricular fibrillation