Electrocardiographic Changes in Pregnant Patients With Congenital Heart Disease For the STORCC Investigators

Maria A. Pabon; Amrit Misra; Kimberlee Gauvreau; Madeline E. Duncan; Ava Conklin; Katherine E. Economy; Fred M. Wu; Thomas Tadros; Anne Marie Valente; Shivani R. Aggarwal; Nael Aldweib; Alex Alexander; Laith Alshawabkeh; Tooba Z. Anwer; Nancy Barker; Fernando Baraona Reyes; Yonatan Buber; Jean Marie Carabuena; Matthew Carazo; Christopher DeZorzi; Vedang Diwanji; Sheila Drakeley; Valeria Duarte; Sarah Rae Easter; Gabriele Egidy Assenza; Kimberlee Gauvreau; Julia Graf; Michelle Gurvitz; Daniel Halpern; Amy Harmon; Kelsey Hickey; Jenna Hynes; Caitlyn Joyce; William P. Knapp; Navya Krishna; Michael Landzberg; Matthew Lippmann; Anais Marenco; Sarah E. Miller; Mary Mullen; Alexander Opotowsky; Sara Partington; Tony Pastor; Saraubh Rajpal; Anna Ray; Carla P. Rodriguez-Monserrate; Carrie Rouse; Zoe Schefter; Keri Shafer; Michael N. Singh; Ada C.Stefanescu Schmidt; Bushra Taha; Allison L. Tsao; Shailendra Upadhyay; Christopher Valle; Sara Villegas-Keech; Alexandria F. Williams; Fred Wu

doi:10.1111/anec.70037

Electrocardiographic Changes in Pregnant Patients With Congenital Heart Disease For the STORCC Investigators

Maria A. Pabon, Amrit Misra, Kimberlee Gauvreau, Madeline E. Duncan, Ava Conklin, Katherine E. Economy, Fred M. Wu, Thomas Tadros, Anne Marie Valente, Shivani R. Aggarwal, Nael Aldweib, Alex Alexander, Laith Alshawabkeh, Tooba Z. Anwer, Nancy Barker, Fernando Baraona Reyes, Yonatan Buber, Jean Marie Carabuena, Matthew Carazo, Christopher DeZorziVedang Diwanji, Sheila Drakeley, Valeria Duarte, Sarah Rae Easter, Gabriele Egidy Assenza, Kimberlee Gauvreau, Julia Graf, Michelle Gurvitz, Daniel Halpern, Amy Harmon, Kelsey Hickey, Jenna Hynes, Caitlyn Joyce, William P. Knapp, Navya Krishna, Michael Landzberg, Matthew Lippmann, Anais Marenco, Sarah E. Miller, Mary Mullen, Alexander Opotowsky, Sara Partington, Tony Pastor, Saraubh Rajpal, Anna Ray, Carla P. Rodriguez-Monserrate, Carrie Rouse, Zoe Schefter, Keri Shafer, Michael N. Singh, Ada C.Stefanescu Schmidt, Bushra Taha, Allison L. Tsao, Shailendra Upadhyay, Christopher Valle, Sara Villegas-Keech, Alexandria F. Williams, Fred Wu

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Electrocardiograms (EKGs) are routinely performed in pregnant patients with pre-existing cardiovascular disease. However, in pregnant patients with congenital heart disease (CHD), EKG changes during gestation have not been explored. Methods: We performed a retrospective study of pregnant patients with CHD enrolled in the STORCC initiative. Patients were included if they had at least two EKGs across the perinatal period and were grouped by specific conditions: atrial septal defect (ASD), tetralogy of Fallot, congenital pulmonary stenosis, coarctation of the aorta (CoA), bicuspid aortic valve (BAV), systemic right ventricle (SRV), and Fontan circulation. EKG parameters were measured in all available EKGs by two investigators, blinded to diagnosis and time of gestation. Results: One hundred and seventy pregnant patients were included. There was a statistically significant increase in HR from pre-pregnancy to third trimester in all groups except for those with Fontan and SRV. Patients with ASD and BAV had a statistically significant increase in their QTc (ASD:13 ms, p = 0.017; BAV:7 ms, p = 0.018) during pregnancy. QRS duration was shorter (4 ms) in the third trimester for patients with ASD (p = 0.033) and CoA (p = 0.014). Despite these individual findings, EKG parameters remained within normal limits and regressed to baseline in the postpartum period. Conclusions: Patients with CHD have statistically significant EKG changes throughout pregnancy, but the values remain within normal limits. Like patients without heart disease, those with CHD increase their HR during pregnancy, except individuals with SRV and Fontan, who appear to lack capacity for physiologic HR augmentation.

Original language	English (US)
Article number	e70037
Journal	Annals of Noninvasive Electrocardiology
Volume	30
Issue number	1
DOIs	https://doi.org/10.1111/anec.70037
State	Published - Jan 2025

Keywords

adult congenital heart disease
congenital heart disease
electrocardiogram
heart rate
pregnancy

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

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10.1111/anec.70037

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Pabon, M. A., Misra, A., Gauvreau, K., Duncan, M. E., Conklin, A., Economy, K. E., Wu, F. M., Tadros, T., Valente, A. M., Aggarwal, S. R., Aldweib, N., Alexander, A., Alshawabkeh, L., Anwer, T. Z., Barker, N., Reyes, F. B., Buber, Y., Carabuena, J. M., Carazo, M., ... Wu, F. (2025). Electrocardiographic Changes in Pregnant Patients With Congenital Heart Disease For the STORCC Investigators. Annals of Noninvasive Electrocardiology, 30(1), Article e70037. https://doi.org/10.1111/anec.70037

Pabon, MA, Misra, A, Gauvreau, K, Duncan, ME, Conklin, A, Economy, KE, Wu, FM, Tadros, T, Valente, AM, Aggarwal, SR, Aldweib, N, Alexander, A, Alshawabkeh, L, Anwer, TZ, Barker, N, Reyes, FB, Buber, Y, Carabuena, JM, Carazo, M, DeZorzi, C, Diwanji, V, Drakeley, S, Duarte, V, Easter, SR, Assenza, GE, Gauvreau, K, Graf, J, Gurvitz, M, Halpern, D, Harmon, A, Hickey, K, Hynes, J, Joyce, C, Knapp, WP, Krishna, N, Landzberg, M, Lippmann, M, Marenco, A, Miller, SE, Mullen, M, Opotowsky, A, Partington, S, Pastor, T, Rajpal, S, Ray, A, Rodriguez-Monserrate, CP, Rouse, C, Schefter, Z, Shafer, K, Singh, MN, Schmidt, ACS, Taha, B, Tsao, AL, Upadhyay, S, Valle, C, Villegas-Keech, S, Williams, AF & Wu, F 2025, 'Electrocardiographic Changes in Pregnant Patients With Congenital Heart Disease For the STORCC Investigators', Annals of Noninvasive Electrocardiology, vol. 30, no. 1, e70037. https://doi.org/10.1111/anec.70037

@article{9b76e69808364aae92741ebb52874088,

title = "Electrocardiographic Changes in Pregnant Patients With Congenital Heart Disease For the STORCC Investigators",

abstract = "Background: Electrocardiograms (EKGs) are routinely performed in pregnant patients with pre-existing cardiovascular disease. However, in pregnant patients with congenital heart disease (CHD), EKG changes during gestation have not been explored. Methods: We performed a retrospective study of pregnant patients with CHD enrolled in the STORCC initiative. Patients were included if they had at least two EKGs across the perinatal period and were grouped by specific conditions: atrial septal defect (ASD), tetralogy of Fallot, congenital pulmonary stenosis, coarctation of the aorta (CoA), bicuspid aortic valve (BAV), systemic right ventricle (SRV), and Fontan circulation. EKG parameters were measured in all available EKGs by two investigators, blinded to diagnosis and time of gestation. Results: One hundred and seventy pregnant patients were included. There was a statistically significant increase in HR from pre-pregnancy to third trimester in all groups except for those with Fontan and SRV. Patients with ASD and BAV had a statistically significant increase in their QTc (ASD:13 ms, p = 0.017; BAV:7 ms, p = 0.018) during pregnancy. QRS duration was shorter (4 ms) in the third trimester for patients with ASD (p = 0.033) and CoA (p = 0.014). Despite these individual findings, EKG parameters remained within normal limits and regressed to baseline in the postpartum period. Conclusions: Patients with CHD have statistically significant EKG changes throughout pregnancy, but the values remain within normal limits. Like patients without heart disease, those with CHD increase their HR during pregnancy, except individuals with SRV and Fontan, who appear to lack capacity for physiologic HR augmentation.",

keywords = "adult congenital heart disease, congenital heart disease, electrocardiogram, heart rate, pregnancy",

author = "Pabon, {Maria A.} and Amrit Misra and Kimberlee Gauvreau and Duncan, {Madeline E.} and Ava Conklin and Economy, {Katherine E.} and Wu, {Fred M.} and Thomas Tadros and Valente, {Anne Marie} and Aggarwal, {Shivani R.} and Nael Aldweib and Alex Alexander and Laith Alshawabkeh and Anwer, {Tooba Z.} and Nancy Barker and Reyes, {Fernando Baraona} and Yonatan Buber and Carabuena, {Jean Marie} and Matthew Carazo and Christopher DeZorzi and Vedang Diwanji and Sheila Drakeley and Valeria Duarte and Easter, {Sarah Rae} and Assenza, {Gabriele Egidy} and Kimberlee Gauvreau and Julia Graf and Michelle Gurvitz and Daniel Halpern and Amy Harmon and Kelsey Hickey and Jenna Hynes and Caitlyn Joyce and Knapp, {William P.} and Navya Krishna and Michael Landzberg and Matthew Lippmann and Anais Marenco and Miller, {Sarah E.} and Mary Mullen and Alexander Opotowsky and Sara Partington and Tony Pastor and Saraubh Rajpal and Anna Ray and Rodriguez-Monserrate, {Carla P.} and Carrie Rouse and Zoe Schefter and Keri Shafer and Singh, {Michael N.} and Schmidt, {Ada C.Stefanescu} and Bushra Taha and Tsao, {Allison L.} and Shailendra Upadhyay and Christopher Valle and Sara Villegas-Keech and Williams, {Alexandria F.} and Fred Wu",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s). Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC.",

year = "2025",

month = jan,

doi = "10.1111/anec.70037",

language = "English (US)",

volume = "30",

journal = "Annals of Noninvasive Electrocardiology",

issn = "1082-720X",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "1",

}

TY - JOUR

T1 - Electrocardiographic Changes in Pregnant Patients With Congenital Heart Disease For the STORCC Investigators

AU - Pabon, Maria A.

AU - Misra, Amrit

AU - Gauvreau, Kimberlee

AU - Duncan, Madeline E.

AU - Conklin, Ava

AU - Economy, Katherine E.

AU - Wu, Fred M.

AU - Tadros, Thomas

AU - Valente, Anne Marie

AU - Aggarwal, Shivani R.

AU - Aldweib, Nael

AU - Alexander, Alex

AU - Alshawabkeh, Laith

AU - Anwer, Tooba Z.

AU - Barker, Nancy

AU - Reyes, Fernando Baraona

AU - Buber, Yonatan

AU - Carabuena, Jean Marie

AU - Carazo, Matthew

AU - DeZorzi, Christopher

AU - Diwanji, Vedang

AU - Drakeley, Sheila

AU - Duarte, Valeria

AU - Easter, Sarah Rae

AU - Assenza, Gabriele Egidy

AU - Gauvreau, Kimberlee

AU - Graf, Julia

AU - Gurvitz, Michelle

AU - Halpern, Daniel

AU - Harmon, Amy

AU - Hickey, Kelsey

AU - Hynes, Jenna

AU - Joyce, Caitlyn

AU - Knapp, William P.

AU - Krishna, Navya

AU - Landzberg, Michael

AU - Lippmann, Matthew

AU - Marenco, Anais

AU - Miller, Sarah E.

AU - Mullen, Mary

AU - Opotowsky, Alexander

AU - Partington, Sara

AU - Pastor, Tony

AU - Rajpal, Saraubh

AU - Ray, Anna

AU - Rodriguez-Monserrate, Carla P.

AU - Rouse, Carrie

AU - Schefter, Zoe

AU - Shafer, Keri

AU - Singh, Michael N.

AU - Schmidt, Ada C.Stefanescu

AU - Taha, Bushra

AU - Tsao, Allison L.

AU - Upadhyay, Shailendra

AU - Valle, Christopher

AU - Villegas-Keech, Sara

AU - Williams, Alexandria F.

AU - Wu, Fred

PY - 2025/1

Y1 - 2025/1

N2 - Background: Electrocardiograms (EKGs) are routinely performed in pregnant patients with pre-existing cardiovascular disease. However, in pregnant patients with congenital heart disease (CHD), EKG changes during gestation have not been explored. Methods: We performed a retrospective study of pregnant patients with CHD enrolled in the STORCC initiative. Patients were included if they had at least two EKGs across the perinatal period and were grouped by specific conditions: atrial septal defect (ASD), tetralogy of Fallot, congenital pulmonary stenosis, coarctation of the aorta (CoA), bicuspid aortic valve (BAV), systemic right ventricle (SRV), and Fontan circulation. EKG parameters were measured in all available EKGs by two investigators, blinded to diagnosis and time of gestation. Results: One hundred and seventy pregnant patients were included. There was a statistically significant increase in HR from pre-pregnancy to third trimester in all groups except for those with Fontan and SRV. Patients with ASD and BAV had a statistically significant increase in their QTc (ASD:13 ms, p = 0.017; BAV:7 ms, p = 0.018) during pregnancy. QRS duration was shorter (4 ms) in the third trimester for patients with ASD (p = 0.033) and CoA (p = 0.014). Despite these individual findings, EKG parameters remained within normal limits and regressed to baseline in the postpartum period. Conclusions: Patients with CHD have statistically significant EKG changes throughout pregnancy, but the values remain within normal limits. Like patients without heart disease, those with CHD increase their HR during pregnancy, except individuals with SRV and Fontan, who appear to lack capacity for physiologic HR augmentation.

AB - Background: Electrocardiograms (EKGs) are routinely performed in pregnant patients with pre-existing cardiovascular disease. However, in pregnant patients with congenital heart disease (CHD), EKG changes during gestation have not been explored. Methods: We performed a retrospective study of pregnant patients with CHD enrolled in the STORCC initiative. Patients were included if they had at least two EKGs across the perinatal period and were grouped by specific conditions: atrial septal defect (ASD), tetralogy of Fallot, congenital pulmonary stenosis, coarctation of the aorta (CoA), bicuspid aortic valve (BAV), systemic right ventricle (SRV), and Fontan circulation. EKG parameters were measured in all available EKGs by two investigators, blinded to diagnosis and time of gestation. Results: One hundred and seventy pregnant patients were included. There was a statistically significant increase in HR from pre-pregnancy to third trimester in all groups except for those with Fontan and SRV. Patients with ASD and BAV had a statistically significant increase in their QTc (ASD:13 ms, p = 0.017; BAV:7 ms, p = 0.018) during pregnancy. QRS duration was shorter (4 ms) in the third trimester for patients with ASD (p = 0.033) and CoA (p = 0.014). Despite these individual findings, EKG parameters remained within normal limits and regressed to baseline in the postpartum period. Conclusions: Patients with CHD have statistically significant EKG changes throughout pregnancy, but the values remain within normal limits. Like patients without heart disease, those with CHD increase their HR during pregnancy, except individuals with SRV and Fontan, who appear to lack capacity for physiologic HR augmentation.

KW - adult congenital heart disease

KW - congenital heart disease

KW - electrocardiogram

KW - heart rate

KW - pregnancy

UR - http://www.scopus.com/inward/record.url?scp=85214429139&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85214429139&partnerID=8YFLogxK

U2 - 10.1111/anec.70037

DO - 10.1111/anec.70037

M3 - Article

C2 - 39763164

AN - SCOPUS:85214429139

SN - 1082-720X

VL - 30

JO - Annals of Noninvasive Electrocardiology

JF - Annals of Noninvasive Electrocardiology

IS - 1

M1 - e70037

ER -

Electrocardiographic Changes in Pregnant Patients With Congenital Heart Disease For the STORCC Investigators

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