title: Pregnancy course and outcomes in women with arrhythmogenic right ventricular cardiomyopathy.
abstract: To characterise pregnancy course and outcomes in women with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C).
  
  
  
  From a combined Johns Hopkins/Dutch ARVD/C registry, we identified 26 women affected with ARVD/C (by 2010 Task Force Criteria) during 39 singleton pregnancies >13 weeks (1-4 per woman). Cardiac symptoms, treatment and episodes of sustained ventricular arrhythmias (VAs) and heart failure (HF) ≥ Class C were characterised. Obstetric outcomes were ascertained. Incidence of VA and HF were compared with rates in the non-pregnant state. Long-term disease course was compared with 117 childbearing-aged female patients with ARVD/C who had not experienced pregnancy with ARVD/C.
  
  
  
  Treatment during pregnancy (n=39) included β blockers (n=16), antiarrhythmics (n=6), diuretics (n=3) and implantable cardioverter defibrillators (ICDs) (n=28). In five pregnancies (13%), a single VA occurred, including two ICD-terminated events. Arrhythmias occurred disproportionately in probands without VA history (p=0.045). HF, managed on an outpatient basis, developed in two pregnancies (5%) in women with pre-existing overt biventricular or isolated right ventricular disease. All infants were live-born without major obstetric complications. Caesarean sections (n=11, 28%) had obstetric indications, except one (HF). β Blocker therapy was associated with lower birth weight (3.1±0.48 kg vs 3.7±0.57 kg; p=0.002). During follow-up children remained healthy (median 3.4 years), and mothers were without cardiac mortality or transplant. Neither VA nor HF incidence was significantly increased during pregnancy. ARVD/C course (mean 6.5±5.6 years) did not differ based on pregnancy history.
  
  
  
  While most pregnancies in patients with ARVD/C were tolerated well, 13% were complicated by VA and 5% by HF.
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA Department of Cardiology/Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Anke R
authors.initials: AR
authors.lastname: Hodes
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Crystal
authors.initials: C
authors.lastname: Tichnell
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Anneline S J M
authors.initials: AS
authors.lastname: Te Riele
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Brittney
authors.initials: B
authors.lastname: Murray
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Groeneweg
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Abhishek C
authors.initials: AC
authors.lastname: Sawant
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Russell
authors.affiliation: Department of Genetics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Karin Y
authors.initials: KY
authors.lastname: van Spaendonck-Zwarts
authors.affiliation: Department of Cardiology/Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Maarten P
authors.initials: MP
authors.lastname: van den Berg
authors.affiliation: Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Wilde
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Harikrishna
authors.initials: H
authors.lastname: Tandri
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Judge
authors.affiliation: Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands.
authors.forename: Richard N W
authors.initials: RN
authors.lastname: Hauer
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.affiliation: Department of Cardiology/Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands Department of Genetics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J Peter
authors.initials: JP
authors.lastname: van Tintelen
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: James
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000628:therapy; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D015142:Baltimore / Q000453:epidemiology; D016022:Case-Control Studies; D002585:Cesarean Section; D002657:Child Development; D002675:Child, Preschool; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D050498:Live Birth; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D012042:Registries; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000889:Anti-Arrhythmia Agents