ONLINE APPENDIX
ROPAC Investigators
Site
Investigators
Innsbruck, Austria
E. Donhauser , J. Stein
Leuven, Belgium
W. Budts
Gent, Belgium
J. De Backer
Brussels, Belgium
M. Morissens
Hamilton, Ontario, Canada
E. Gordon , L. Walter
Montreal, Canada
A. Marelli , A.R. Montesclaros
Prague, Czech Republic
J. Popelova
Hradec Kralove, Czech
Republic
Z. Vavera
Minia, Egypt
N. Taha
Benha (Kaliubeya), Egypt
A. El Nagar, H.H. Ebaid , W.A. El Sayed Makled
Cairo, Egypt
K. Sorour, M.A. Meguid Mahdy, Z. Ashour
Alexandria, Egypt
Y. Elrakshy
Paris, France
B. Iung
Paris, France
L. Iserin, M. Ladouceur
Tbilisi, Georgia
D. Maisuradze
München, Germany
H. Kaemmerer, S. Mebus, K.T.M. Schneider B. Kuschel
Muenster, Germany
A. Hellige, A. Kempny, R. Schmidt
Essen, Germany
C. Wald
Oldenburg, Germany
R. Motz
Berlin, Germany
F. Berger, N. Nagdyman
Athens, Greece
A. Frogoudaki
Rehovot, Israel
S. Goland
Beer Yakov, Israel
A. Blatt
Torino, Italy
A. Maina, C. Bossotti, E. Gollo, E. Vasario, G. Boccuzzi, T. Todros, V.
Donvito, W. Grosso Marra
Bolzano, Italy
C. Romeo , R. Crepaz
Milano, Italy
V. Fesslova
Massa, Italy
P. Festa
Palermo, Italy
M.G. Carmina
Chiba, Japan
K. Niwa, T. Ikeda, Y. Matsuda
Vilnius, Lithuania
L. Gumbiene
Msida, Malta
A. Cassar, M. Caruana
Rotterdam, the Netherlands
J. Roos-Hesselink, Y. Karamermer, A. Can, J. Duvekot, J. Cornette
Groningen, the Netherlands
E. Pieper
Utrecht, the Netherlands
C. van Oppen
The Hague, the Netherlands
C. De Groot
Geldrop, the Netherlands
P. Polak
Oslo, Norway
M. Estensen
Krakow, Poland
A. Lesniak-Sobelga, M. Olszowska, P. Podolec, S. Wisniowska-Smialek
Lisboa, Portugal
L. de Sousa
Coimbra, Portugal
N. Guerra
Bucharest, Romania
V. Petrescu
Izhevsk, Russian federation
I. Ravilevich Gaisin, L.V. Shilina
Moscow, Russian Federation
N. Sharashkina, O. Tkacheva
Belgrade, Serbia
L. Jovovic
Ljubljana, Slovenia
M. Kozelj
Barcelona, Spain
A. Pijuan Domenech
Barcelona, Spain
M.T. Subirana
Madrid, Spain
J.M. Oliver
Bilbao, Spain
N. Murga
Lund, Sweden
U. Thilen
Bern, Switzerland
M. Schwerzmann
Abu Dhabi, United Arab
Emirates
W. Almahmeed
Dubai, United Arab Emirates
A. Yusufali, E. Alhatou, F. Hussain
London, United Kingdom
P. Nihoyannopoulos
Norwich, Norfolk, United
L. Freeman, R. Hall
Kingdom
Southampton, United
Kingdom
G. Veldtman, J. Kerr, L. Tellett
Hershey, United States
J. Botti, J. Ting, W. R. Davidson
Seattle, United States
M. Gurvitz, C. Otto
Palo Alto, California, United
States
C. Talluto, D. Murphy, M.G. Perlroth
Detroit, Michigan, United
States
K. Chintala, P. Gupta
Online Table 1. Differences between patients enrolled in centers with and without AF/Afl
events
Sites with
Sites without
AF/Afl events
AF/Afl events
p value
Congenital heart disease
47.5%
78.7%
<0.001
Mitral valve disease
28.7%
10.2%
<0.001
Cardiomyopathy
9.3%
4.8%
0.001
Right sided lesion
18.6%
26.8%
0.001
Left sided lesion
58.8%
36.4%
<0.001
Shunt lesion
17.1%
30.4%
<0.001
3.9%
3.1%
0.403
Nulliparity
46.2%
52.3%
0.029
Developing countries
23.5%
7.5%
<0.001
Clinical signs of heart failure
9.9%
11.0%
0.522
Rhythm: Atrial fibrillation before pregnancy
2.6%
1.5%
0.167
Mechanical valve
5.8%
2.7%
0.005
13.8%
14.9%
0.562
26.4%
16.2%
0.105
NYHA class > 2
Beta-blocker before pregnancy
Echo prior to pregnancy:
Fractional Shortening < 30%
Online Table 2. Atrial fibrillation in pregnant women with structural heart disease as reported in the medical literature
Author
Year
No of
patients
with AF
Cardiac history
Therapy
Onset during pregnancy
Maternal outcome
Fetal outcome
Whittemore (1)
1982
2 (Afl)
VSD (ventriculotomy)
AR (valvulotomy)
Digoxin
NA
NA
NA
Ayhan (2)
1991
7
5 MVR,
AC, diuretics
NA
1 died;
NA
2 MVR&AVR
3 developed CHF
Suri (3)
1999
2
RHD, MVR
AC
NA
NA
NA
Autore (4)
2002
1
PAF, HCM
None
NA
NSVD
OK
Les´niak-Sobelga
(5)
2003
5
Severe MS, AF
AC, digoxin,
diuretics
4 at baseline;
LSCS
NA
Silversides (6)
2006
12
CHD, PAF
Digoxin, sotalol,
other beta
blockers
3 in 1st trim; 6 in 2nd trim;
2 in 3rd trim; 1 during
delivery
NA
Adverse
outcome in 8
Li (7)
2007
3
RHD, CHF, AF in 2
patients
Digoxin and
metoprolol
3rd trim and immediate
postpartum
NA
OK
Lin (8)
2008
1
Moderate TR and MR,
LAE, RAE
DC shock
22 wks
LSCS at 38 wks
OK
Risius (9)
2008
1
Senning procedure, RFA
for SVT
DC shock
3rd trim
LSCS at 36 wks
OK
1 in 3rd trim
Kockova (10)
2008
2
HCM&VT in one, WPW
in other
IV Ibutilide
30 wks; 23 wks
NSVD
OK
Walker (11)
2011
1
mildly dilated RV and
moderate to severe TR
None
30 wks
LSCS at 40 wks
OK
for breech
AC= anticoagulation, AF= atrial fibrillation, Afl= atrial flutter, AR= aortic regurgitation, AVR= aortic valve replacement, CHF= congestive heart failure,
DC= direct current, CHD = congenital heart disease, HCM= hypertrophic cardiomyopathy, LAE= left atrial enlargement, LSCS= lower section cesarean
section, MR= mitral regurgitation, MS= mitral stenosis, MVR= mitral valve replacement, NA= not available, NSVD= normal spontaneous vaginal delivery,
PAF= paroxysmal atrial fibrillation, RAE= right atrial enlargement, RFA= radio frequency ablation, RHD= rheumatic heart disease, RV= right ventricle,
SVT= supraventricular tachycardia, TR= tricuspid regurgitation, trim= trimester, VSD= ventricle septum defect, WPW= Wolf Parkinson White
Online Table 3. Atrial fibrillation in pregnant women without structural heart disease as reported in the medical literature
Author
Year
No of patients
with AF
History
Cardiac
abnormality
Possible
precipitating
factor
Therapy
Onset
during
pregnancy
Maternal
outcome
Fetal outcome
Mozo de Rosalesa
(12)
1994
1
None
WPW
-
Ajmaline
33 wks
NSVD
OK
Brackley (13)
1994
1
AF
None
-
None
32 wks
NSVD
OK
Carson (14)
2002
1
Palpitation
after
caffeine
and
chocolate
None
Terbutaline,
chocolate
cereal
procainamide 1 35 wks
mg followed by
500 mg after 90
min
NSVD
OK
Lashgari (15)
2003
1
None
None
Terbutaline
Diltiazem
31 wks
NSVD
OK
Gowda (16)
2003
1
None
None
-
None
38 wks
NSVD
OK
Kuczkowski (17)
2004
1
None
None
-
None
During LSCS
LSCS
OK
Parasuraman (18)
2006
1
None
None
Nifedipine
DC shock
33 wks
NSVD
OK
Walsh (19)
2008
1
None
None
-
Flecainide
37 wks
NA
NA
Cacciotti (20)
2009
1
None
None
-
IV metoprolol
36 wks
LSCS at 38
wks
OK
Cheung (21)
2013
1
None
None
Nifedipine
and atosiban
IV diltiazem
33 wks
NSVD
OK
Huisman (22)
2013
2
NA
NA
NA
NA
NA
NA
NA
Abbreviations: see Table 1.
1.
Whittemore R, Hobbins JC, Engle MA. Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. Am J
Cardiol. 1982 Sep;50(3):641-51.
2.
Ayhan A, Yapar EG, Yuce K, Kisnisci HA, Nazli N, Ozmen F. Pregnancy and its complications after cardiac valve replacement. Int J Gynaecol
Obstet. 1991 Jun;35(2):117-22.
3.
Suri V, Sawhney H, Vasishta K, Renuka T, Grover A. Pregnancy following cardiac valve replacement surgery. Int J Gynaecol Obstet. 1999
Mar;64(3):239-46.
4.
Autore C, Conte MR, Piccininno M, Bernabo P, Bonfiglio G, Bruzzi P, et al. Risk associated with pregnancy in hypertrophic cardiomyopathy. J Am
Coll Cardiol. 2002 Nov 20;40(10):1864-9.
5.
Lesniak-Sobelga A, Tracz W, KostKiewicz M, Podolec P, Pasowicz M. Clinical and echocardiographic assessment of pregnant women with valvular
heart diseases--maternal and fetal outcome. Int J Cardiol. 2004 Mar;94(1):15-23.
6.
Silversides CK, Harris L, Haberer K, Sermer M, Colman JM, Siu SC. Recurrence rates of arrhythmias during pregnancy in women with previous
tachyarrhythmia and impact on fetal and neonatal outcomes. Am J Cardiol. 2006 Apr 15;97(8):1206-12.
7.
Li JM, Nguyen C, Joglar JA, Hamdan MH, Page RL. Frequency and outcome of arrhythmias complicating admission during pregnancy: experience
from a high-volume and ethnically-diverse obstetric service. Clin Cardiol. 2008 Nov;31(11):538-41.
8.
Lin CH, Lee CN. Atrial fibrillation with rapid ventricular response in pregnancy. Taiwan J Obstet Gynecol. 2008 Sep;47(3):327-9.
9.
Risius T, Mortensen K, Meinertz T, Willems S. Cluster of multiple atrial tachycardias limited to pregnancy after radiofrequency ablation following
senning operation. Int J Cardiol. 2008 Jan 24;123(3):e48-50.
10.
Kockova R, Kocka V, Kiernan T, Fahy GJ. Ibutilide-induced cardioversion of atrial fibrillation during pregnancy. J Cardiovasc Electrophysiol. 2007
May;18(5):545-7.
11.
Walker MG, Colman J, Silversides CK, Gandhi S, Kingdom J. Maternal atrial arrhythmia detected by uterine artery Doppler. J Obstet Gynaecol Can.
2011 Aug;33(8):851-3.
12.
Mozo de Rosales F, Moreno J, Bodegas A, Melchor JC, Fernandez LL, Aranguren G. Conversion of atrial fibrillation with ajmaline in a pregnant
woman with Wolff-Parkinson-White syndrome. Eur J Obstet Gynecol Reprod Biol. 1994 Jul;56(1):63-6.
13.
KJ B. Paroxysmal atrial fibrillation in pregnancy. Current Obstetrics and Gynaecology. 1994;4(3):170-1.
14.
Carson MP, Fisher AJ, Scorza WE. Atrial fibrillation in pregnancy associated with oral terbutaline. Obstet Gynecol. 2002 Nov;100(5 Pt 2):1096-7.
15.
Lashgari S, Kueck AS, Oyelese Y. Atrial fibrillation in pregnancy associated with oral terbutaline therapy. Obstet Gynecol. 2003 Apr;101(4):814.
16.
Gowda RM, Punukollu G, Khan IA, Wilbur SL, Navarro VS, Vasavada BC, et al. Lone atrial fibrillation during pregnancy. Int J Cardiol. 2003
Mar;88(1):123-4.
17.
Kuczkowski KM. New onset transient lone atrial fibrillation in a healthy parturient: deja vu. Int J Cardiol. 2004 Nov;97(2):339.
18.
Parasuraman R, Gandhi MM, Liversedge NH. Nifedipine tocolysis associated atrial fibrillation responds to DC cardioversion. BJOG. 2006
Jul;113(7):844-5.
19.
Walsh CA, Manias T, Patient C. Atrial fibrillation in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2008 May;138(1):119-20.
20.
Cacciotti L, Camastra GS, Ansalone G. Atrial fibrillation in a pregnant woman with a normal heart. Intern Emerg Med. 2010 Feb;5(1):87-8.
21.
Cheung CS, Li TK, Lee CP. Maternal atrial fibrillation after sequential use of nifedipine and atosiban for treatment of preterm labor: case report. Eur
J Obstet Gynecol Reprod Biol. 2013 Feb;166(2):229.
22.
Huisman CM, Zwart JJ, Roos-Hesselink JW, Duvekot JJ, van Roosmalen J. Incidence and predictors of maternal cardiovascular mortality and severe
morbidity in The Netherlands: a prospective cohort study. PLoS One. 2013;8(2):e56494.