Ablation of severe drug-resistant tachyarrhythmia during pregnancy.
OBJECTIVE
The goal of this study was to describe mapping and ablation of severe arrhythmias during pregnancy, with minimum or no X-ray exposure. Treatment of tachyarrhythmia in pregnancy is a clinical problem. Pharmacotherapy entails a risk of adverse effects and is unsuccessful in some patients. Radiofrequency ablation has been performed rarely, because of fetal X-ray exposure and potential maternal and fetus complications. GROUP AND METHOD: Mapping and ablation was performed in 9 women (age 24-34 years) at 12-38th week of pregnancy. Three had permanent junctional reciprocating tachycardia, and 2 had incessant atrial tachycardia. Four of them had left ventricular ejection fraction < or =45%. One patient had atrioventricular nodal reciprocating tachycardia requiring cardioversion. Three patients had Wolff-Parkinson-White syndrome. Two of them had atrial fibrillation with ventricular rate 300 bpm and 1 had atrioventricular tachycardia 300 bpm. Fetal echocardiography was performed before and after the procedure.


RESULTS
Three women had an electroanatomic map and ablation done without X-ray exposure. The mean fluoroscopy time in the whole group was 42 +/- 37 seconds. The mean procedure time was 56 +/- 18 minutes. After the procedure, all women and fetuses were in good condition. After a mean period of 43 +/- 23 months follow up (FU), all patients were free of arrhythmia without complications related to ablation either in the mothers or children.


CONCLUSIONS
Ablation can be performed safely with no or minimal radiation exposure during pregnancy. In the setting of malignant, drug-resistant arrhythmia, ablation may be considered a therapeutic option in selected cases.
Institute of Cardiology, Alpejska 42, Warsaw, Poland. lszumowski@ikard.pl
Lukasz
L
Szumowski
Ewa
E
Szufladowicz
Michał
M
Orczykowski
Robert
R
Bodalski
Paweł
P
Derejko
Andrzej
A
Przybylski
Piotr
P
Urbanek
Mariusz
M
Kuśmierczyk
Edward
E
Koźluk
Frederic
F
Sacher
Prashanthan
P
Sanders
Joanna
J
Dangel
Michel
M
Haissaguerre
Franciszek
F
Walczak
D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D004351:Drug Resistance; D022062:Electrophysiologic Techniques, Cardiac; D005060:Europe; D005260:Female; D005471:Fluoroscopy; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D011829:Radiation Dosage; D018570:Risk Assessment; D012720:Severity of Illness Index; D013021:South Australia; D054139:Tachycardia, Reciprocating / Q000601:surgery; D013617:Tachycardia, Supraventricular / Q000601:surgery; D017211:Treatment Failure; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014927:Wolff-Parkinson-White Syndrome / Q000601:surgery; D055815:Young Adult
D000889:Anti-Arrhythmia Agents