Cardiac and Perinatal Outcomes Among Pregnancies with Maternal Cardiac Arrhythmias

Background Atrial fibrillation/flutter (AF/AFL) and supraventricular tachycardia (SVT) are common arrhythmias in pregnancy. While known to contribute to adverse outcomes, large studies have not evaluated cardiac and perinatal outcomes in individuals with these arrhythmias.

To characterize the cardiac/perinatal outcomes of patients with AF/AFL and SVT in pregnancy.

We performed a retrospective cohort study utilizing Epic Cosmos, a dataset from over 1,500 US hospitals. We identified pregnancies between October 25, 2021 and October 24, 2024 of patients with a diagnosis of AF/AFL and SVT using simultaneous diagnoses codes for each arrhythmia and pregnancy. A control group of pregnancies without arrhythmias was also identified. Descriptive statistics were calculated, and comparisons were made with ANOVA or Chi-square tests, as appropriate.

During the study period, there were 8,642 pregnant patients with AF/AFL, 29,638 with SVT, and 5,372,171 healthy pregnant controls. Patients with these arrhythmias were older (AF/AFL: 33±6, SVT: 32±6, control: 31±6, p<0.0001) with a higher BMI than the control group. Those with arrhythmias experienced higher rates of heart failure (AF/AFL: 10.8%, SVT: 3.8%, control: 0.3%), thromboembolism, stroke, preterm birth, and cesarean delivery (all p<0.0001). Patients with AF/AFL had 23.9 times higher odds of stroke compared to the control group (95% CI 21.3-27.0).

While both AF/AFL and SVT are associated with adverse cardiac and perinatal outcomes, AF/AFL was associated with the highest risk of heart failure and stroke. Further research is needed to understand optimal perinatal AF/AFL management, especially anticoagulation therapy given the high rate of maternal stroke. Competing Interest Statement Gianna Wilkie has served as a consultant for VentureWell. Funding Statement Gianna Wilkie is funded by the NICHD through K23HD111526 and Lara Kovell is funded by the NHLBI through K23HL163450. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Due to the publicly available/de-identified nature of this data, this study was deemed to be exempt from the institutional review board at the UMass Chan School of Medicine. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability The data is available through Epic Cosmos and can be shared at request. All data is deidentified.