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Are Frequent Premature Ventricular

Contractions in Pregnant Patients


Always Benign?
Kristopher Knott1 and Amanda Varnava1,2
1. West Hertfordshire Hospitals NHS Trust, 2. Imperial College
Healthcare NHS Foundation Trust
Background and Methods
• Premature ventricular contractions (PVC) in
pregnancy are said to be benign in patients
with structurally normal hearts despite a
paucity of evidence.
• In this retrospective observational study, the
medical records of 12 patients with multiple
PVCs (>1,000/24h) were looked at.
Results
• 12 patients were referred with PVCs ranging from
1,096 to 29,483 in 24 hours.
• 11 out of 12 PVCs were monomorphic, 9 out of
12 captured on ECG.
• The PVCs in 8 were of left bundle branch inferior
axis, in 1 patient there were 2 distinct
morphologies.
• Initial left ventricular ejection fraction ranged
from 55-87%.
• Two patients had poor outcomes.
Results
Patient 1
• 28 year old presenting with PVCs in her
3rd trimester.
• Background of idiopathic sinus
tachycardia and anterior mitral valve
prolapse.
• 6,715 (4.6%) monomorphic PVCs, left
bundle branch, inferior axis.
• At 38 weeks she became hypertensive
requiring emergency caesarean section
and then suffered from ventricular
tachycardia and PEA arrest.
• Circulation was restored after 1 cycle of
cardio-pulmonary resuscitation.
• She required biventricular assist device
implantation for severe cardiac failure
• The diagnosis made was peripartum
cardiomyopathy
Figure 1. 24 hour ECG
Patient 2

Figure 2a. 12 lead ECG


• 27 year old presenting asymptomatic in the 1st trimester.
• Developed a gradual deterioration of left ventricular function,
falling to 37% which persisted post partum.
• Underwent caesarean section at 36 weeks gestation.
• Ectopy continued to increase post partum requiring 2 catheter
ablations (mid basal, lateral and mid RV wall).
• Following the second ablation the LV function normalised but
repolarisation abnormalities persist on the 12 lead ECG.
• Diagnosis – tachycardia / ectopy induced cardiomyopathy Figure 2b. 24 hour ECG
Conclusion
• 10 of 12 patients with multiple PVCs
proceeded to have uncomplicated deliveries
and 2 had poor outcomes.
• Multiple PVCs in pregnancy should be
investigated with specialist assessment and
investigation.
• Possible mechanisms include ectopy heralding
peripartum cardiomyopathy and an ectopy
induced cardiomyopathy.

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