Abstract
Background: Cardiac arrhythmias are associated with increased maternal morbidity. Few data exist on trends of delivery-related hospitalizations complicated by arrhythmias. Methods: We used the National Inpatient Sample database to identify delivery hospitalizations for women ages 18-49 years between 2009 to 2019 and coding data from the 9 th and 10 th editions of the International Classification of Diseases to identify supraventricular tachycardias (SVT), atrial fibrillation (AF), atrial flutter, ventricular tachycardia (VT), and ventricular fibrillation (VF). Data were stratified by age, race/ethnicity, maternal comorbidities, hospital size and setting, and type of insurance coverage. Primary outcome was in-hospital mortality, secondary outcome was adverse pregnancy outcomes (APOs), cesarean section, and cardiovascular decompensation. Multivariate logistic regression was used to understand the predictors of arrhythmia during delivery hospitalization. Results: Among 41,320,000 delivery hospitalizations, 141,372 were complicated by arrhythmias; SVT (13%), AF (8%), and VT (3%). The incidence of arrhythmia increased between 2009-2014 and again from 2014-2019 ( Fig 1 ). Women above 30 years of age, with valvular disease, heart failure, obesity, hypertension, hyperlipidemia, diabetes mellitus, or previous MI had a greater likelihood of arrhythmia during delivery ( Fig 1 , all p <0.0001). Though in-hospital mortality was low, maternal morbidity from cardiogenic shock (0.20 v 0.0%), caesarean section (44.6 v 32%), and APOs such as preeclampsia (9.36 v 3.57%) were increased (p <0.0001) for women with arrhythmia. Conclusions: Women with known CV risk factors are more likely to experience arrhythmia during delivery. Those with arrhythmias also have an increased likelihood of cesarean sections, APOs and cardiogenic shock. The data highlight the importance of CVD risk factor modification and better pregnancy care for those at higher risk of morbidity.
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