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Comment & Response
August 26, 2020

Interpreting the Need for Implantable Loop Recorder Monitoring in Pregnant Women at High Risk of Arrhythmias

Author Affiliations
  • 1Faculty of Medicine, Imperial College London, London, United Kingdom
  • 2Faculty of Medicine and Surgery, University of Malta, Msida, Malta
  • 3College of Medical and Dental Services, University of Birmingham, Birmingham, United Kingdom
JAMA Cardiol. 2020;5(11):1304. doi:10.1001/jamacardio.2020.3521

To the Editor We congratulate Sliwa et al1 for their excellent analysis on the use of implantable loop recorders (ILRs) in addition to 24-hour Holter electrocardiography to improve the detection of arrhythmias in pregnant women with cardiovascular disease compared with 24-hour Holter electrocardiography alone. We believe these findings to be pertinent, as a 2019 study by Moulig et al2 observed 66 patients with peripartum cardiomyopathy over 5 years and found that 17% had arrhythmias, including paroxysmal supraventricular tachycardia, ventricular tachycardia, or ventricular fibrillation. It should be noted the large number of arrhythmias found in this population may be because 9 patients had wearable cardioverter-defibrillators inserted at diagnosis. Of these patients, 8 also had permanent implantable cardioverter-defibrillators inserted.2 These data show that patients with peripartum cardiomyopathy remain at high risk of arrhythmias for prolonged periods and could see considerable benefit from monitoring as described by Sliwa et al.1

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