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. 2024 Nov 22;6(2):176-182.
doi: 10.1016/j.hroo.2024.11.016. eCollection 2025 Feb.

Outcomes of pregnancy-related hospitalizations in women with pacemakers and defibrillators

Vardhmaan Jain  1 , Kartik Gupta  2 , Neal K Bhatia  1 , Mikhael F El-Chami  1 , Kamala P Tamirisa  3 , Annabelle S Volgman  4 , Faisal M Merchant  1
Affiliations

Outcomes of pregnancy-related hospitalizations in women with pacemakers and defibrillators

Vardhmaan Jain et al. Heart Rhythm O2. .

Abstract

Background: There is limited information on pregnancy outcomes in women who have previously undergone implantation of cardiac implantable electronic devices (CIEDs).

Objective: The study sought to describe outcomes of pregnancy related hospitalizations in women with CIEDs.

Methods: The National Inpatient Sample database was analyzed to identify pregnancy-related hospitalizations between 2016 and 2021.

Results: We identified 23,611,200 weighted pregnancy-related hospitalizations, of which 11,220 (0.05%) had a history of CIED implantation. Of these, 5105 had permanent pacemakers (PPMs) and 6115 had implantable cardioverter-defibrillators (ICDs). The mortality rate during pregnancy-related hospitalization was significantly higher among women with ICDs (0.9%) compared with those without CIEDs (0.01%). Of note, there were no in-hospital deaths among pregnant women with PPMs. After adjusting for covariates, the excess mortality risk in women with ICDs was no longer noted. However, pregnant women with ICDs remained at higher risk of cardiogenic shock (odds ratio 3.06, 95% confidence interval 2.17-4.30) and need for mechanical circulatory support (odds ratio 2.37, 95% confidence interval 1.48-3.80).

Conclusion: In a nationwide cohort of pregnancy-related hospitalizations, a history of CIED implantation was rare, occurring in about 0.05% of women. In-hospital mortality was significantly higher among pregnant women with ICDs. However, after adjustment for covariates, the excess mortality risk was no longer observed. Pregnant women with ICDs remain at increased risk of cardiogenic shock and need for mechanical circulatory support, even after adjusting for covariates. Outcomes for pregnant women with PPMs are generally excellent and comparable to those without CIEDs.

Keywords: Cardiomyopathy; Heart block; Implantable cardioverter-defibrillator; Maternal outcomes; Pacemaker; Pregnancy.

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Figures

Figure 1
Figure 1
Annual number of pregnancy-related hospitalizations with women with prior permanent pacemaker (PPM) and prior implantable cardioverter-defibrillator (ICD). The percentage out of all pregnancy-related hospitalizations is presented in parentheses.
Figure 2
Figure 2
Unadjusted incidence of primary and secondary outcomes among pregnancy-related hospitalizations, stratified by prior cardiac implantable electronic device (CIED) status. AKI = acute kidney injury; ICD = implantable cardioverter-defibrillator; PPM = permanent pacemaker.
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