Catheter ablation without fluoroscopy in pregnant with supraventricular tachycardia: substrate characterization and outcomes

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Arrhythmia is a common extra genital pathology in pregnant. Catheter ablation without fluoroscopy demonstrated similar efficacy and safety to fluoroscopy-based procedure. However, data on pregnant population is limited. Purpose To evaluate the arrhythmias substrate and outcomes of catheter ablation without fluoroscopy in pregnant with supraventricular tachycardia. Methods 44 pregnant with drug refractory supraventricular tachycardia (Mean age 26.4±3.1 years, mean gestation age 22.8±2.1 weeks) undergoing catheter ablation. The substrate characteristics, course of pregnancy, outcomes and arrhythmia recurrence documented during 24 months follow-up. Results Ablation was performed under the guidance of CARTO (n=20; 45.5%) and EnSite NavX mapping systems (n=24; 54.5%) without fluoroscopy in all cases. In the majority of cases ablated substrate was slow conduction way (n=21, 47.7%). Ablation of accessory pathways performed in 18 pregnant (40.9%).Combination of accessory pathways with slow conduction ways was present in 5 women (11.4%). Accessory pathways located at left free wall (n=8), in right free wall (n=5), right medioseptal (n=5) and posteroseptal (n=5). The median procedural time was 71 minutes (interquartile range 60-89). Acute success rate was 100%. Procedure related complication was observed in one women (2.3%), who developed an ileofemoral thrombosis. There was no termination of pregnancy after ablation. In two women (4.5%) was preterm delivery at 35 and 36 weeks of gestation. In the majority of cases was vaginal delivery (n=35; 79.5%). In two cases were placental abruption and preeclampsia (4.5%). There were 45 live births (in one case were twins) without any malformation. Neonatal outcomes: fetal birth weight was 3198.5±542.5 grams, 5 minute Apgar score was 8.4±1.1. There were no maternal and fetal mortality. At follow up period arrhythmia recurrence was not documented. Conclusions Pregnant mostly underwent catheter ablation for atrioventricular nodal reentrant tachycardia. Catheter ablation without fluoroscopy are safe and feasible in pregnant.