Pregnancy in women with arrhythmogenic right ventricular cardiomyopathy (ARVC)

In arrhythmogenic right ventricular cardiomyopathy (ARVC) fat and scar tissue replace the normal heart muscle in the right ventricle. The right sided pumping chamber gets bigger and contraction is impaired.

Again there is a risk of getting arrhythmias — this time more ventricular arrhythmias than atrial — but you can get both. And again, ARVC is a genetic condition.

So if you have symptoms of breathlessness and you get pregnant, the breathlessness is going to get worse. If you have arrhythmias they are going to get worse but again we treat arrhythmias aggressively and try to damp down any rhythm problems during pregnancy. As you can imagine, the last thing you want is someone having a prolonged arrhythmia and needing a cardioversion (an electric shock to help the heart return to its normal rhythm).

So we try to damp the arrhythmia down, even just short bursts of small amounts of fast rhythm. We will give beta-blockers to do this. If needed we can use more potent anti-arrhythmics. I have had to use amiodarone twice, even though it can affect the baby, as it was the only medicine that prevented arrhythmias but not in patients with cardiomyopathy but in those with congenital heart disease. We essentially have to use the medication that is going to maintain normal rhythm as it’s very important for a good outcome for mother and baby.

Again aspirin is used as a blood thinner if the right ventricle is enlarged and there are no arrhythmias, whereas low molecular weight heparin injections are given if there are arrhythmias.

What to expect

Again you should expect obstetric reviews as normal. You will have regular echo every six weeks to ensure heart function remains stable. We would still aim for vaginal delivery as we do in most women with heart problems and we’d consider early delivery if there were any major problems that do not respond to drug treatment. There is a low risk of complications in pregnancy if the ARVC is mild and a higher risk if the ARVC is severe and there is poor function of the right ventricle.

Again you can get a more objective idea of the function of the right ventricle from the echo and the exercise test. But there is minimal literature as ARVC is a relatively new condition so pregnancy data is still not out there.

If symptoms are there before pregnancy they are going to get worse during pregnancy. Most symptoms do respond to medical treatment with tablets. Most adverse events can be anticipated and discussed at the pre-pregnancy review so that you know what to expect. Occasionally we will deliver a baby early for the sake of maternal health but I am pleased to say that major events are very rare