Cesarean section in a patient with familial cardiomyopathy and a cardioverter-defibrillator

Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie
Don A Frost, James A Dolak

Abstract

To describe the impact of maternal automatic implantable cardioverter-defibrillator (AICD) therapy on pregnancy outcome, and discuss the clinical rationale for regional anesthesia in parturients with AICDs. A 20-yr-old primigravida with a history of familial cardiomyopathy and AICD placement presented at 39 weeks gestational age for elective labour induction. Ultimately, the patient underwent a Cesarean section for a failed induction. Her AICD was deactivated during the peripartum period, although the pacing function remained active as she had an underlying heart rhythm of less than 34 beat.min(-1). The patient had continuous electrocardiogram monitoring via an external defibrillating unit to which she remained connected by external defibrillator pads. Labour analgesia and surgical anesthesia were provided with a lumbar epidural dosed with varying concentrations of bupivacaine. This management resulted in an excellent maternal and fetal outcome. Automatic implantable cardioverter-defibrillators are being utilized more frequently in the obstetric population, and appear compatible with good fetal outcomes. Experience with the anesthetic management of these patients is markedly limited - primarily involving reports of general anes...Continue Reading

References

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Citations

Jun 21, 2008·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Roanne Preston
Mar 7, 2014·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Stéphane BouléSalem Kacet
Jul 21, 2010·Acta Anaesthesiologica Taiwanica : Official Journal of the Taiwan Society of Anesthesiologists·Renu Sinha, Vimi Rewari

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