Maternal and neonatal outcomes in pregnant patients with Brugada Syndrome - a multicentre retrospective study (2014-2025).
Bhatia K., Curtis S., Cauldwell M., James R., Hendon-John L., Acott C., Naganathar S., Stocker LJ., Thornton P., Banerjee A., Medha L., Adamson D., McAuliffe FM., UK and Ireland Brugada Syndrome Collaborators .
BACKGROUND: Brugada Syndrome is an inherited channelopathy that predisposes to ventricular arrhythmias. Triggers include fever, enhanced vagal tone, electrolyte abnormalities and certain medications, including local anaesthetics and propofol. Multicentre studies evaluating anaesthetic management in conjunction with maternal and neonatal outcomes in pregnant patients with Brugada Syndrome are lacking. METHODS: In this retrospective cohort study, outcomes from 64 pregnancies in 57 patients with Brugada Syndrome across 12 maternity units in the UK and Ireland were reviewed (2014-2025). Outcomes included labour analgesia and anaesthesia, documentation of pre-pregnancy counselling, mode of delivery, postpartum haemorrhage rate, uterotonic use, implantable cardioverter-defibrillator management, arrhythmia during delivery, and neonatal outcomes. RESULTS: There were 62 live births (96.9%) and two terminations (3.1%). Of those diagnosed with Brugada Syndrome pre-pregnancy (n=53), counselling was documented in 37.7% (20/53) patients. Caesarean delivery was performed in 42.2% of pregnancies, with 37.5% vaginal deliveries and 17.2% instrumental deliveries. Of 48 labouring patients, 35.5% received neuraxial labour analgesia, 25% received systemic opioids, and 18.8% received 50:50 mixture of oxygen: nitrous oxide as sole analgesic. Neuraxial anaesthesia was utilised in 96.3% of caesarean deliveries. General anaesthesia using propofol was used for one caesarean and for both surgical terminations. The postpartum haemorrhage rate was 38.7% uterotonics. No arrhythmia events were recorded during labour and delivery. Implantable cardioverter-defibrillator was deactivated during four interventions in theatre. Preterm birth occurred in 6.5% and neonatal intensive care unit admission in 1.6%. CONCLUSION: No episodes of arrhythmias were recorded in this cohort of pregnant patients with Brugada Syndrome who were exposed to neuraxial analgesia and anaesthesia. These data will provide evidence for counselling and clinical decision-making in this population before and during pregnancy.