Advances in Clinical and Experimental Medicine
2017, vol. 26, nr 1, January-February, p. 129–134
Publication type: original article
Catheter ablation of cardiac arrhythmias in pregnancy without fluoroscopy: A case control retrospective study
1 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
2 Chair of Emergency Medicine, Wroclaw Medical University, Poland
3 Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warszawa, Poland
Background. Cardiac arrhythmias are common in pregnant women. In most cases, they do not require treatment other than rest, electrolyte supplementation and avoidance of strong coffee and tea. Persistent arrhythmia or the ventricular rate running at a high frequency may cause hemodynamic deterioration in the fetus or in both the fetus and the mother.
Objectives. The aim of this study was to assess the prevalence and characteristics of arrhythmias in pregnant women who qualified for ablation as well as the feasibility and specific features of these interventions.
Material and Methods. The study group consisted of 11 pregnant women (16–32 Hbd) aged 31 + 6. The control group consisted of 111 women aged 15–50 years (34 + 10), scheduled for ablation in 2012. The medical records of the selected study and control groups were analyzed and the following data was retrieved: age, the reason the ablation procedure was performed, the ablation duration, the number of radiofrequency applications, the total duration of radiofrequency applications, gravity, and comorbidities.
Results. In the study group, accessory pathway related arrhythmias or atrial tachycardia (AT) accounted for 62% of cases, whereas in the control group for 32% (p = 0.042). All the procedures in the study group were performed with an electroanatomical system without fluoroscopy. All of the patients, but one, had no recurrence of arrhythmia. There were no complications and no overt effects were noted in the fetus.
Conclusion. Ablation of arrhythmias during pregnancy is rare. An experienced surgeon using electroanatomical system is usually able to ablate arrhythmic substrate without the use of X-ray fluoroscopy. The most prevalent causes of arrhythmias in pregnant women requiring ablation are accessory pathway and AT focus.
safety, ablation, cardiac arrhythmias
- European Society of Gynecology (ESG); Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM), Regitz-Zagrosek V, Blomstrom Lundqvist C., et al. ESC Committee for Practice Guidelines. ESC 2011 Guidelines on the manage-ment of cardiovascular diseases during pregnancy: the task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011; 32:3147–3197.
- Shotan A, Ostrzega E, Mehra A, Johnson JV, Elkayam U. Incidence of arrhythmias in normal pregnancy and relation to palpitations, dizziness, and syncope. Am J Cardiol. 1987; 79:1061–1064.
- Sommerkamp SK, Gibson A. Cardiovascular disasters in pregnancy. Emerg Med Clin North Am. 2012;30:949–959.
- Damilakis J, Theocharopoulos N, Perisinakis K, et al. Conceptus radiation dose and risk from cardiac catheter ablation procedures. Circulation. 2001;104:893–897.
- Clark JM, Bigelow AM, Crane SS, Khoury FR. Catheter ablation of supraventricular tachycardia without fluoroscopy during pregnancy. Obstet Gynecol. 2014;123:Suppl.44S–45S.
- Stec S, Krynski T, Baran J, Kulakowski P. „Rescue” ablation of electrical storm in arrhythmogenic right ventricular cardiomyopathy in preg-nancy. BMC Cardiovasc Disord. 2013;13:58.
- Ferguson JD, Helms A, Mangrum JM, DiMarco JP. Ablation of incessant left atrial tachycardia without fluoroscopy in a pregnant woman. J Cardiovasc Electrophysiol. 2011; 22:346–349.
- Berruezo A, Díez GR, Berne P, Esteban M, Mont L, Brugada J. Low exposure radiation with conventional guided radiofrequency catheter ablation in pregnant women. Pacing Clin Electrophysiol. 2007;30:1299–1302.
- Bombelli F, Lagona F, Salvati A, Catalfamo L, Ferrari AG, Pappone C. Radiofrequency catheter ablation in drug refractory maternal supra-ventricular tachycardias in advanced pregnancy. Obstet Gynecol. 2003;102:1171–1173.
- Bongiorni MG, Di Cori A, Soldati E, et al. Radiofrequency catheter ablation of atrioventricular nodal reciprocating tachycardia using intracar-diac echocardiography in pregnancy. Europace. 2008;10:1018–1021.
- Domínguez A, Iturralde P, Hermosillo AG, Colin L, Kershenovich S, Garrido LM. Successful radiofrequency ablation of an accessory pathway during pregnancy. Pacing Clin Electrophysiol. 1999;22:131–134.
- Forgione FN, Acquati F, Caico SI, Tagliagambe L. Incessant ectopic atrial tachycardia in pregnancy: Radiofrequency catheter ablation in im-mediate postpartum with disappearance of tachycardia-related dilated cardiomyopathy. G Ital Cardiol. 1994; 24:755–761.
- Kanjwal Y, Kosinski D, Kanj M, Thomas W, Grubb B. Successful radiofrequency catheter ablation of left lateral accessory pathway using transseptal approach during pregnancy. J Interv Card Electrophysiol. 2005;13:239–242.
- Manjaly ZR, Sachdev B, Webb T, Rajappan K. Ablation of arrhythmia in pregnancy can be done safely when necessary. Eur J Obstet Gynecol Reprod Biol. 2011;157:116–117.
- Szumowski L, Szufladowicz E, Orczykowski M, et al. Ablation of severe drug-resistant tachyarrhythmia during pregnancy. J Cardiovasc Elec-trophysiol. 2010; 21:877–882.
- Wu H, Ling LH, Lee G, Kistler PM. Successful catheter ablation of incessant atrial tachycardia in pregnancy using three-dimensional electro-anatomical mapping with minimal radiation. Intern Med J. 2012;42:709–712.
- Lee SH, Chen SA, Wu TJ, et al. Effects of pregnancy on first onset and symptoms of paroxysmal supraventricular tachycardia. Am J Cardiol. 1995;76: 675–678.
- Gleicher N, Meller J, Sandler R, Sullum S. Wolff–Parkinson-White Syndrome in pregnancy. Obst Gynecol. 1981;58:748–752.
- Hubbard W, Jenkins B, Ward D. Persistent atrial tachycardia in pregnancy. Br Med J. 1983;287:327.
- Widerhorn J, Widerhorn A, Rahimtoola S, Elkayam U. WPW syndrome during pregnancy: increased incidence of supraventricular arrhythmias. Am Heart J. 1992; 123:769–798.
- Tawam M, Levine J, Mendelson M, Goldberger J, Dyer A, Kadish A. Effect of pregnancy on paroxysmal supraventricular tachycardia. Am J Cardiol. 1993;72: 838–840.