Ablation of incessant left atrial tachycardia without fluoroscopy in a pregnant woman.
BACKGROUND
Management of symptomatic atrial arrhythmia in pregnancy remains a challenge. In this case report, a pregnant woman with incessant tachycardia underwent successful left atrial ablation. The entire procedure was performed without fluoroscopy.


RESULTS
A 20-year-old woman, 27 weeks pregnant, was admitted with congestive cardiac failure and incessant atrial tachycardia. She had an elevated brain natriuretic peptide (BNP) and chest X-ray demonstrating heart failure. The 12-lead electrocardiogram (ECG) showed atrial tachycardia with a cycle length of 310 ms, inverted P waves in lead I and the inferior leads, and a ventricular rate of 84 bpm during 2:1 block. Echocardiogram showed a global reduction in left ventricular function with a left ventricular ejection fraction (LVEF) of 0.40. Electrical cardioversion failed. Rate control could not be achieved with beta-blockers and calcium antagonists. Amiodarone with repeat cardioversion was also unsuccessful. The patient then underwent catheter ablation. The entire procedure was performed using intracardiac echocardiography (ICE) and electroanatomical mapping with no fluoroscopy. Electrophysiology (EP) study and an activation map of the left atrium confirmed a focal left atrial tachycardia which was successfully ablated. Six weeks postablation, the left ventricular function had normalized and the patient delivered a healthy child at term, without complication.


CONCLUSIONS
Ablation of left atrial tachycardia using ICE and electroanatomical guidance is feasible in pregnant women.
Ferguson
John D
JD
Cardiovascular Medicine, Department of Internal Medicine, University of Virginia, Lee Street, Charlottesville, VA 22908, USA. jdf7h@virginia.edu
Helms
Adam
A
Mangrum
J Michael
JM
DiMarco
John P
JP
D016279:Atrial Function, Left; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005471:Fluoroscopy; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D050498:Live Birth; D011247:Pregnancy; D015641:Radiography, Interventional / Q000009:adverse effects; D020127:Recovery of Function; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D016277:Ventricular Function, Left; D055815:Young Adult