Evidence-based Management of Arrhythmogenic Right Ventricular Cardiomyopathy in Pregnancy

Abstract

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder resulting in fibrofatty replacement of the myocardium. Genetic mutations in genes encoding for desmosome proteins result in a ventricular myocardium prone to arrhythmias and heart failure. Although ARVC is known for a few decades, most of the outcomes in pregnancy are reported recently. Pregnancy leads to significant physiological changes with excess mechanical stress on the myocardium. All the retrospective studies suggest that pregnancy is well tolerated in these patients despite the high risk of arrhythmias and heart failure. Our review focuses on the most up-to-date evidence on the management of ARVC patients during the antepartum and postpartum period.

Lay abstract

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder resulting in the replacement of normal heart tissue by fibrous and fatty tissue. The patient is more likely to develop heart failure and rhythm disorders, which can be life threatening. Women undergo many physiological changes during pregnancy, which put excess stress on the heart. Our understanding of pregnancy outcomes in ARVC patients has grown significantly during the last decade. Despite the high risk for complications, studies have reported that pregnancy is well tolerated in these patients. Our review focuses on the most up-to-date evidence on the optimization of ARVC patients before pregnancy, management during pregnancy, and postdelivery.

Keywords:

• antiarrhythmic medications
• arrhythmogenic right ventricular cardiomyopathy
• ARVC
• inherited cardiomyopathies
• pregnancy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.