The efficacy and safety of non-fluoroscopic catheter ablation of arrhythmias in pregnancy after mid-long-term follow-up: a single- center experience

Abstract

Funding Acknowledgements Type of funding sources: None. Background Despite the incidence of arrhythmias in pregnancy data on non-fluoroscopic catheter ablation in pregnant women and perinatal outcomes is limited. Purpose the aim of this study is to prospectively assess the efficacy and safety of non-fluoroscopic catheter ablation in pregnant women with arrhythmias. Methods 44 pregnant women (mean age of 28,2 ± 4,2 years, mean gestation age 24,4 ±3,8 weeks) indicated for catheter ablation were enrolled. The ablation was performed under the guidance of CARTO (n = 20; 45%) and Ensite Precision systems (n = 24; 55%) without fluoroscopy. Ablation characteristics, procedure-related complications and clinical outcomes were evaluated during 18 months follow-up. Results all 44 cases of ablation were successful. There were 14 (31,8%) ablation of accessory pathways - in left free wall (n = 8), in right free wall (n = 5), posteroseptal (n = 1). 19 patients (43,2%) underwent ablation for atrioventricular nodal reentrant tachycardia. In 3 cases (6,8%) were combination of accessory pathways with slow conduction ways. Ablation of the right ventricular outflow tract was performed in 8 cases (18,2%) of frequent premature ventricular contractions and idiopathic ventricular tachycardia. The median procedural time was 71 minutes (interquartile range 54-97). Procedural complication was documented in 1 patient (2,3%), who developed an ileofemoral thrombosis. Perinatal outcomes: spontaneus vaginal (n = 35; 79.5%) or vaginal-assisted (n = 4; 9.1%) delivery were in the majority. Five pregnancies (11.4%) were delivered by cesarean section. Mean median gestational age at delivery was 39 ± 1,12 weeks. In one case was placental abruption (2,3%). Maternal cardiac events was none declared. There were 44 live births (in all pregnancies). Fetal birth weight was 3324,39 ± 625,1 grams, 5 minute Apgar was 8,81 ± 1,9. There were no maternal and fetal mortality. During follow-up there were no arrhythmia recurrence. Conclusions non-fluoroscopic catheter ablation of arrhythmias is feasible and can be safety performed in pregnancy. Our data suggests that these pregnancies were with good perinatal and neonatal outcomes.

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 ].…”

“…The indications for ablation were not given for 55 (43.0%) patients [ 3 , 12 , 23 , 32 , 37 ], while detailed indications were known for the remaining 73 (57.0%) patients. Unresponsiveness of arrhythmia to drug therapy was an indication for an ablation therapy in most patients ( Table I ).…”

“…An accessory pathway was identified in 28 patients: a left accessory pathway in 16 (57.1%) [ 3 , 12 – 14 , 20 , 24 , 29 , 30 , 32 ], a right accessory pathway in 10 (35.7%) [ 11 , 12 , 19 , 21 , 27 , 30 ], a posteroseptal accessory pathway in 1 (3.6%) [ 12 ] and a Coumel accessory pathway in 1 (3.6%) patient [ 14 ].…”

“…One of the patients had ablations twice in the third trimester due to recurrence of arrhythmia after the first ablation [ 18 ]. Ablation was performed under fluoroscopy in 21 (16.4%) patients [ 2 , 3 , 8 , 13 , 14 , 17 , 18 , 20 , 31 , 33 , 36 , 37 ], and zero-fluoroscopy technique was applied in 108 ablations of 107 (83.6%) patients [ 1 , 3 , 4 , 7 , 11 , 12 , 15 , 16 , 19 , 21 – 30 , 32 , 34 , 35 ] (χ 2 = 115.6, p < 0.001). The fluoroscopic exposure lasted 322.8 ±439.1 (range: 55–1,776; median: 109) s ( n = 15), and the radiation dose was reported for 16 patients, with a mean of 9.6 ±10.3 (range: 0.1–35.1; median: 10) mGy ( n = 10).…”

Sex and racial disparities in catheter ablation

“… 18 , 19 Fluoroless catheter ablation during pregnancy has been performed successfully but requires further research, as data currently are limited. 21 …”