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Review

Management of Implantable Cardioverter-Defibrillators during Pregnancy—A Systematic Review

1
Department of Internal Medicine II, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
2
Division of Cardiology, Hospital Maria Hilf Mönchengladbach, 41063 Mönchengladbach, Germany
3
Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, 48149 Münster, Germany
*
Author to whom correspondence should be addressed.
Academic Editor: Patrizio Mazzone
J. Clin. Med. 2021, 10(8), 1675; https://doi.org/10.3390/jcm10081675
Received: 7 February 2021 / Revised: 28 March 2021 / Accepted: 29 March 2021 / Published: 14 April 2021
Background: With the advent of implantable cardioverter-defibrillator (ICD) technology in recent decades, patients with inherited or congenital cardiomyopathy have a greater chance of survival into adulthood. Women with ICDs in this group are now more likely to reach reproductive age. However, pregnancy represents a challenge for clinicians, as no guidelines for the treatment of pregnant women with an ICD are currently available. Methods: To analyze this issue, we performed a systematic screening of the literature using the keywords: pregnancy with ICD, lead fracture in pregnancy, lead thrombi in pregnancy, ventricular tachycardia in pregnancy, inappropriate shocks in pregnancy, ICD discharge in pregnancy and ICD shock in pregnancy. Of 1101 publications found, 27 publications were eligible for further analysis (four retrospective trials and 23 case reports). Results: According to physiological changes in pregnancy, resulting in an increase in heart rate and cardiac output, a vulnerability for malignant arrhythmias and device-related complications in ICD carriers might be suspected. While the literature is limited on this issue, maternal complications including arrhythmia burden with following ICD therapies, thromboembolic events and lead complications as well as inappropriate shock therapy have been reported. According to the limited available studies, associated risk seems not to be more frequent than in the general population and depends on the underlying cardiac pathology. Furthermore, worsening of heart failure and related cardiovascular disease have been reported with associated risk of preterm delivery. These observations are exaggerated by restricted applications of diagnostics and treatment due to the risk of fetal harm in this population. Conclusions: Due to limited data on management of ICDs during pregnancy, further scientific investigations are required. Consequently, careful risk assessment with individual risk evaluation and close follow ups with interdisciplinary treatment are recommended in pregnant ICD carriers. View Full-Text
Keywords: management; pregnancy; ICD; cardiomyopathy management; pregnancy; ICD; cardiomyopathy
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MDPI and ACS Style

Topf, A.; Bacher, N.; Kopp, K.; Mirna, M.; Larbig, R.; Brandt, M.C.; Kraus, J.; Hoppe, U.C.; Motloch, L.J.; Lichtenauer, M. Management of Implantable Cardioverter-Defibrillators during Pregnancy—A Systematic Review. J. Clin. Med. 2021, 10, 1675. https://doi.org/10.3390/jcm10081675

AMA Style

Topf A, Bacher N, Kopp K, Mirna M, Larbig R, Brandt MC, Kraus J, Hoppe UC, Motloch LJ, Lichtenauer M. Management of Implantable Cardioverter-Defibrillators during Pregnancy—A Systematic Review. Journal of Clinical Medicine. 2021; 10(8):1675. https://doi.org/10.3390/jcm10081675

Chicago/Turabian Style

Topf, Albert, Nina Bacher, Kristen Kopp, Moritz Mirna, Robert Larbig, Mathias C. Brandt, Johannes Kraus, Uta C. Hoppe, Lukas J. Motloch, and Michael Lichtenauer. 2021. "Management of Implantable Cardioverter-Defibrillators during Pregnancy—A Systematic Review" Journal of Clinical Medicine 10, no. 8: 1675. https://doi.org/10.3390/jcm10081675

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