Catheter ablation for tachyarrhythmias during pregnancy

Abstract

Introduction: Refractory arrhythmias during pregnancy pose challenges to physicians.

Aim: To give an overview of catheter ablation for tachyarrhythmias during pregnancy, and to discuss the indications of the procedure and the outcomes of both mother and fetus.

Material and methods: The study materials were based on comprehensive literature retrieval of the pertinent articles published since 2000.

Results: The indications for catheter ablation were refractory arrhythmias unresponsive to drug therapy in most of the cases followed by requirement of cardioversion. Atrioventricular nodal reentrant tachycardia was the most common arrhythmia developed during pregnancy. Pregnancy complications were present in 2.4% of the cases. There was no mortality among the pregnant patients. Fetal adverse events occurred in 3.1% of the cases, more in the fluoroscopy than in the zero-fluoroscopy group. The patient cohort with a radiation dose of > 50 mGy in one-third of the cases had a 14.3% fetal adverse event rate. Fetal adverse events occurred only in the second trimester, not in the other two trimesters.

Conclusions: Drug-refractory and poorly tolerated tachycardias in pregnant patients warrant catheter ablation. Zero-fluoroscopy technique under guidance with three-dimensional mapping systems is preferred and strict minimal fluoroscopy is only used in extreme necessity. As ablation in the second trimester was associated with a probable higher fetal adverse event rate, it is suggested that ablation is preferably performed in the third trimester.

Keywords: catheter ablation; fluoroscopy; pregnancy; supraventricular tachycardia.

Figure 1

Flowchart of literature inclusion and exclusion

Figure 2

Protocol of a multidisciplinary team in managing tachyarrhythmias in a pregnant patient 3D – three-dimensional, ICE – intracardiac echocardiography, M-F – maternal-fetal medicine, pt – patient, TEE – transesophageal echocardiography.