Clinical evidence of pacemaker implantation during gestation: a case series

Although recommended avoid any intervention during gestation in cases of poor tolerance to high degree atrioventricular block, pacemaker implantation may be necessary in pregnant women.

To present outcomes of pacemaker implantation during gestation.

This prospective, single center study included 10 cases of pacemaker implantation during gestation (median age of patient - 26 years old at 18 weeks of gestation). We evaluated the further course of gestation and obstetric outcomes after implantation in comparison with pregnant with tachyarrythmias (n=111).

Among 121 pregnant women with varying arrhythmias high degree atrioventricular block was detected in 10 cases (8,3%). In 6 cases this bradyarrhythmia diagnosed for the first time in gestation (60%). All pregnant with high degree atrioventricular block had clinical signs: dizziness and weakness (100%), syncope (70%), episodes of low blood pressure (100%). Pacemaker implantation performed due to hemodynamic instability and poor tolerance of bradyarrhythmia in all cases. Using electroanatomical mapping (Ensite Precision system)and echocardiographic guidance helped to reduce fluoroscopy time. For one pregnant implanted leadless pacemaker (Micra) with achieved more than 80% atrio-ventricular synchronization. Outcomes: further course of gestation characterized by increased incidence of uterine contractile activity (30%) in cases of high degree atrioventricular block, that was significantly higher than in pregnant with tachyarrhythmias (2%) (p=0.007). There were no differences in the rate of other complication: uterine blood flow violation (20% vs 12%, p=0.520), placental abraption (10% vs 5%, p=0.237) and preeclampsia (10% vs 5%, p=0.237). Vaginal type of delivery was in the majority of cases in both groups (70% vs 86%, p=0.553). Neonatal outcomes characterized with normal range of fetal birth weight (median 3163 vs 3212 grams, p=0.981) and 5 minute Apgar score (median 8.6 vs 8.7, p=0.564). There was no incidence of maternal and fetal mortality. In 12 month follow-up all patient have optimal electrical parameters of devise and remained stable over time.

High degree atrioventricular block in pregnant characterized by increased rate of uterine contractile activity. Pacemaker implantation during gestation can be effectively performed and associated with benign outcomes.