Maternal focal atrial tachycardia during pregnancy: A systematic review

Abstract

Introduction The presentation and optimal management of maternal focal atrial tachycardia (AT) during pregnancy are unknown. The objective of this study is to conduct a comprehensive summary of the existing evidence. Methods and Results A systematic review of all reported cases of maternal focal AT during pregnancy was performed. The primary search queried PubMed using the MeSH terms “supraventricular tachycardia” and “pregnancy.” A stepwise ancillary search included article bibliographies, citations listed by the Google internet search engine, and PubMed using the MeSH terms “atrial tachycardia” and “pregnancy.” In total, 28 citations that described 32 patients were retrieved. A case from our institution was added. Detailed information was available for 30 patients. Clinical characteristics at presentation included a mean ± standard deviation of 28.3 ± 5.7 years for maternal age and 24.6 ± 7.7 weeks for gestation age. Suspected tachycardia‐induced cardiomyopathy was present in 20 of 30 (67%) patients and left ventricular ejection fraction improved in 15 of 15 (100%) patients with follow‐up measurements. Medication failure was common. Focal AT resolved spontaneously after delivery in eight of nine (89%) patients treated with only medications. Automaticity was suggested by discrete electrograms at sites of origin and lack of reported inducibility and termination with programmed stimulation in all patients who underwent electrophysiology studies. There were nine cases of successful catheter ablation with zero fluoroscopy since 2010. Conclusions Automaticity is the dominant mechanism for patients with maternal focal AT during pregnancy. Catheter ablation with zero fluoroscopy is an emerging therapy for medically refractory cases.

Study on the Curative Effect and Safety of Radiofrequency Catheter Ablation of Paroxysmal Atrial Fibrillation via Zero-Fluoroscopy Transseptal Puncture under the Dual Guidance of Electroanatomical Mapping and Intracardiac Echocardiography

“…Zero-fluoroscopy catheter ablation for ventricular tachycardia and supraventricular tachycardia has been proven effective and practicable in routine clinical practice, especially for children and pregnant women [1,2]. However, atrial fibrillation (AF) ablation without fluoroscopy guidance seems relatively complex due to transseptal puncture.…”

Catheter ablation for tachyarrhythmias during pregnancy

“…Therefore, there were 129 occasions in 128 patients for partly preprocedural and 128 occasions in 127 patients for all postprocedural evaluations. The articles were 23 (69.7%) case reports [ 1 , 2 , 4 , 7 , 8 , 15 – 22 , 24 , 26 – 29 , 31 – 35 ], 6 (18.2%) case series [ 11 , 13 , 14 , 30 , 36 , 37 ], 3 (9.1%) retrospective research articles [ 3 , 23 , 25 ] and 1 (3.0%) proceeding abstract [ 12 ].…”

“…Tachyarrhythmias occurred before pregnancy in 24 (42.9%) patients [ 3 , 7 , 8 , 11 , 13 , 21 , 25 , 27 – 29 , 31 , 36 ] and they occurred during pregnancy in 32 (57.1%) patients [ 2 , 3 , 14 , 16 , 17 , 19 , 24 – 26 , 30 , 33 , 35 , 37 ], whereas the onset time was unspecified for 72 patients. No difference was found in the prevalence of tachyarrhythmic onset between before and during pregnancy (χ 2 = 2.286, p = 0.093).…”

“…The clinical presentations were described for 34 patients. One of them was asymptomatic [ 4 ], and 33 patients had a total of 60 clinical presentations, including palpitations in 24 (40%) [ 1 – 3 , 7 , 11 , 13 , 15 , 17 , 19 – 21 , 26 – 28 , 30 , 31 , 33 , 35 , 36 ], dyspnea in 6 (10%) [ 2 , 13 , 16 , 19 , 26 , 37 ], and breathlessness/shortness of breath in 5 (8.3%) [ 26 , 31 , 35 , 37 ]. Patients’ heart rate at presentation was 202.3 ±43.7 (range: 150–300; median: 187) beats/min ( n = 31) [ 1 – 4 , 8 , 11 , 13 – 16 , 18 – 20 , 22 , 26 , 28 , 30 , 31 , 33 , 35 , 37 ].…”

“…One of them was asymptomatic [ 4 ], and 33 patients had a total of 60 clinical presentations, including palpitations in 24 (40%) [ 1 – 3 , 7 , 11 , 13 , 15 , 17 , 19 – 21 , 26 – 28 , 30 , 31 , 33 , 35 , 36 ], dyspnea in 6 (10%) [ 2 , 13 , 16 , 19 , 26 , 37 ], and breathlessness/shortness of breath in 5 (8.3%) [ 26 , 31 , 35 , 37 ]. Patients’ heart rate at presentation was 202.3 ±43.7 (range: 150–300; median: 187) beats/min ( n = 31) [ 1 – 4 , 8 , 11 , 13 – 16 , 18 – 20 , 22 , 26 , 28 , 30 , 31 , 33 , 35 , 37 ]. The left ventricular ejection fraction was 44.9 ±16.0 (range: 18–70; median: 41)% ( n = 25) at presentation.…”