Undiagnosed Ebstein's Anomaly in a Pregnant Woman.

Ebstein's anomaly is an uncommon congenital heart defect characterized by an abnormal tricuspid valve. Pregnancy can be well tolerated, although cyanosis, arrhythmias, and cardiomegaly are associated with poor prognosis. An 18-year-old woman with a history of congenital cardiomyopathy presented at 37 weeks of gestation with hypoxia, dyspnea, central cyanosis, and uterine contractions. The patient underwent emergent cesarean delivery. Echocardiography revealed Ebstein's anomaly with patent foramen ovale and right-to-left shunting. Tricuspid valvuloplasty with primary closure of patent foramen ovale was performed. This case is presented, accompanied by a review of the literature.

Feasibility of automated detection of advanced sleep disordered breathing utilizing an implantable pacemaker ventilation sensor.

OBJECTIVES: This study tested the feasibility of automatically detecting advanced sleep disordered breathing (SDB) from a pacemaker trans-thoracic impedance sensor. BACKGROUND: SDB is prevalent yet under-diagnosed in patients with cardiovascular disease. The potential for automated detection of SDB in patients receiving pacemakers with respiration sensors has not been fully explored. We hypothesized that the trans-thoracic impedance sensor could be utilized for automatic detection of advanced SDB. METHODS: Patients underwent overnight polysomnography (PSG). The pacemaker trans-thoracic impedance signal was simultaneously recorded and time synchronized with the polysomnograph. Cardiovascular health variables were abstracted from medical records. Apnea was defined as cessation of inspiratory airflow lasting 10 seconds or longer. Hypopnea was defined as a reduction of tidal volume of at least 30% from baseline tidal volume, lasting 10 seconds or more. A computer algorithm (PM-A) was developed to automatically detect SDB from the pacemaker impedance sensor data. The performance of automated SDB detection was compared against PSG. RESULTS: Sixty patients (aged 69 +/- 12 years, 45 males) were studied. Advanced SDB (moderate or severe) was diagnosed in 40 patients. Severe SDB (apnea-hypopnea index [AHI]> or = 30) was diagnosed in 32 patients (53%), but only 5 patients had prior diagnosis of the disease. Moderate SDB (30 > AHI > 15) was diagnosed in 8 patients of whom only two were previously diagnosed. Cardiovascular health variables did not predict the presence of advanced SDB. PM-A derived AHI correlated with that of the PSG (r = 0.80, P < 0.01). The algorithm identified patients with advanced SDB with 82% sensitivity and 88% specificity. CONCLUSIONS: It is feasible to automatically measure SDB severity using a pacemaker trans-thoracic impedance sensor. Advanced SDB was frequently undiagnosed in this cohort of pacemaker patients.