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.