目的:这些妇女妊娠期间的心房颤动(AF)/房扑(AFL)与妊娠不良结局有关。
背景:发病率,定时,心脏病患者妊娠期间AF或AFL的后果尚不清楚。
方法:2008年1月至2011年6月,28个国家的60家医院前瞻性地纳入了1,321例先天性心脏病孕妇,心脏瓣膜病,缺血性心脏病,或ROPAC(妊娠和心脏病注册)中的心肌病。我们研究了发病率,发病,以及妊娠期AF/AFL的预测因素,并评估妊娠结局。提供了现有文献的概述。
结果:17名妇女(1.3%)在怀孕期间发生AF/AFL,主要在孕中期(61.5%)。单变量分析确定了以下妊娠中AF/AFL的孕前危险因素:妊娠前AF/AFL(比值比[OR]:7.1,95%置信区间[CI]:1.5至32.8);二尖瓣心脏病(OR:6.9,95%CI:2.6至18.3);使用β受体阻滞剂(OR:3.3,95%CI:1.2至9.0);左侧病变(OR:2.9至95%CI:8.3)。有AF/AFL的女性产妇死亡率高于无AF/AFL的女性(11.8%vs.0.9%;p=0.01),虽然心力衰竭并不常见。低出生体重(<2,500g)在女性中的发生率高于无AF/AFL的女性(35%vs.14%;p=0.02)。
结论:AF/AFL发生在1.3%的妊娠结构性心脏病患者中,在妊娠中期末期达到峰值。心脏病患者妊娠期间的AF/AFL与不良的母体结局有关,并且对胎儿出生体重也有影响。
OBJECTIVE: Atrial fibrillation (AF)/atrial flutter (AFL) during pregnancy in these women is associated with adverse outcome of pregnancy.
BACKGROUND: The incidence, timing, and consequences of AF or AFL during pregnancy in patients with heart disease are not well known.
METHODS: Between January 2008 to June 2011, 60 hospitals in 28 countries prospectively enrolled 1,321 pregnant women with congenital heart disease, valvular heart disease, ischemic heart disease, or cardiomyopathy in the ROPAC (Registry of Pregnancy and Cardiac Disease). We studied the incidence, onset, and predictors of AF/AFL during pregnancy and assessed the pregnancy outcome. An overview of the existing literature is provided.
RESULTS: Seventeen women (1.3%) developed AF/AFL during pregnancy, mainly in the second trimester (61.5%). Univariable analysis identified the following pre-pregnancy risk factors for AF/AFL in pregnancy: AF/AFL before pregnancy (odds ratio [OR]: 7.1, 95% confidence interval [CI]: 1.5 to 32.8); mitral valvular heart disease (OR: 6.9, 95% CI: 2.6 to 18.3); beta-blocker use (OR: 3.3, 95% CI: 1.2 to 9.0); and left-sided lesions (OR: 2.9, 95% CI: 1.0 to 8.3). Maternal mortality was higher in women with than in women without AF/AFL (11.8% vs. 0.9%; p = 0.01), although heart failure was not seen more often. Low birth weight (<2,500 g) occurred more often in women with than in women without AF/AFL (35% vs. 14%; p = 0.02).
CONCLUSIONS: AF/AFL occurs in 1.3% of pregnant patients with structural heart disease with a peak at the end of the second trimester. AF/AFL during pregnancy in cardiac patients is associated with unfavorable maternal outcome and also has an impact on fetal birth weight.