Discussion
CHB, arrhythmia, major brady-, NSVT, asystole, PPCM, LV dysfunction, AV block, arrhythmias, heart failure, tachyarrhythmias
ARRHYTHMIAS, ARRHYTHMIA, DISEASE, VENTRICULAR ESCAPE RHYTHM, ASYSTOLE, COMPLETE HEART BLOCK, EVENT, AV BLOCK, EVENTS, HEART FAILURE, CHB
In this study on extended electrocardiographic monitoring in PPCM, we showed a high prevalence of arrhythmic events. In this regard, ILR in addition to 24 h-Holter monitoring had a significantly higher arrhythmic yield than 24 h-Holter monitoring alone. All major brady- and tachyarrhythmias occurred in the early phase of the disease (i.e., within the first 4 months after diagnosis). Neither 24 h-Holter or ILR monitoring detected any episodes of AF.The most commonly detected VA in this cohort was NSVT, which occurred in four patients (16%), all of which had a severely impaired LVEF. Our reported prevalence of VAs is comparable to studies on the use of the WCD in patients with newly diagnosed PPCM, which also showed a high burden of VAs (12%) [In a recent systematic review and meta-analysis, Sammani et alOne patient with severe heart failure developed third degree AV block 1 week after PPCM diagnosis. The ventricular escape rhythm eventually failed, and the patient demised from asystole before she could reach the hospital. Complete heart block (CHB) at the time of PPCM diagnosis has previously only been described in case reports [24 h-Holter ECG monitoring is an inexpensive and non-invasive diagnostic modality, but is confined to monitoring during the usual 24–48 h weartime [In this study, we could show that ILR in addition to Holter monitoring had a higher yield of arrhythmic events than 24 h-Holter monitoring alone. We also found that patients with severely impaired LV systolic function were at highest risk of arrhythmias, particularly shortly after index diagnosis. We, therefore, recommend that ILR should be considered in the early post-partum period in patients with severe heart failure and/or severe LV dysfunction, especially in patients with symptoms suggestive of an arrhythmia, and particularly when the 24 h-Holter did not detect any arrhythmia. However, larger prospective studies are required to support our recommendations.Our study also highlights the importance of event adjudication of the REVEAL XTPrevious prospective studies on the prevalence of major arrhythmic events in PPCM investigated the use of a WCD [It should be highlighted that WCDs are not available in large parts of the world. As illustrated in the proposed algorithm for the detection and management of arrhythmias (Fig. Proposed algorithm for the diagnosis and management of arrhythmias in PPCM. 