title: Burden of arrhythmias in peripartum cardiomyopathy: Analysis of 9841 hospitalizations.
abstract: BACKGROUND
  Peripartum cardiomyopathy (PPCM) is associated with significant morbidity and mortality. Arrhythmogenic causes of death have been implicated in a significant number of patients. However, there is a dearth of systematic studies evaluating the burden of arrhythmias in PPCM.
  
  
  METHODS
  We used the Healthcare Utilization Project, Nationwide Inpatient Sample database (2007-2012) and identified 9841 hospitalizations for women aged ≥18years with a primary diagnosis of PPCM. Frequency of arrhythmias, utilization of electrophysiologic procedures, length of stay, hospitalization costs and outcomes associated with arrhythmias were determined.
  
  
  RESULTS
  Mean age was 30.05±6.69years. Arrhythmias were present in 18.7% of hospitalized PPCM cohort. Ventricular tachycardia was the most common arrhythmia and was noted in 4.2%. Approximately 2.2% of cases experienced cardiac arrest. Electrical cardioversion was performed in 0.3%, Catheter ablation in 1.9%, PPM implantation in 3.4% and ICD in 6.8% of hospitalizations for PPCM with arrhythmias. In-hospital mortality was 3-times more frequent in arrhythmia cohort (2.1% vs. 0.7%). Hospitalization costs were significantly higher in PPCM with arrhythmias. Elixhauser comorbidity score (adjusted OR:1.10; 95%CI:1.02-1.18; p=0.016), in-hospital mortality (adjusted OR:2.35; 95%CI:1.38-4.02; p=0.002), cardiogenic shock (adjusted OR:2.61; 95%CI:1.44-4.72; p=0.002), utilization of balloon pump (adjusted OR:13.4; 95%CI: 2.55-70.53; p<0.001), Swan-Ganz catheterization (adjusted OR:3.12; 95%CI:1.21-8.06; p=0.019), and coronary angiography (adjusted OR:1.79; 95%CI:1.19-2.70; p=0.005) were significantly associated with arrhythmias in PPCM.
  
  
  CONCLUSIONS
  Arrhythmias were present in 18.7% of PPCM related hospitalizations. Morbidity, in-hospital mortality, length of inpatient stay, hospitalization costs and cardiac procedure utilization were significantly higher in the arrhythmia cohort.
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University School of Medicine, Detroit, MI, USA. Electronic address: smaliket@med.wayne.edu.
authors.forename: Sagar
authors.initials: S
authors.lastname: Mallikethi-Reddy
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Akintoye
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Naveen
authors.initials: N
authors.lastname: Trehan
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Shikha
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Briasoulis
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Kavyashri
authors.initials: K
authors.lastname: Jagadeesh
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Melvyn
authors.initials: M
authors.lastname: Rubenfire
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Luis
authors.initials: L
authors.lastname: Afonso
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D016208:Databases, Factual / Q000706:statistics & numerical data; D004554:Electric Countershock / Q000706:statistics & numerical data*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
keywords: Arrhythmias; Peripartum cardiomyopathy