Abstract
BackgroundRadiofrequency ablation (RFCA) became a treatment of choice in patients with recurrent ventricular tachycardia, ventricular fibrillation, and appropriate interventions of implanted cardioverter-defibrillator (ICD), however, electrical storm (ES) ablation in a pregnant woman has not yet been reported.Case presentationWe describe a case of a successful rescue ablation of recurrent ES in a 26-year-old Caucasian woman during her first pregnancy (23rd week). The arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) was diagnosed 3 years earlier and several drugs as well as 2 ablations failed to control recurrences of ventricular tachycardia. RFCA was performed on the day of the third electric storm. The use of electroanatomic mapping allowed very low X-ray exposure, and after applications in the right ventricular outflow tract, arrhythmia disappeared. Three months after ablation, a healthy girl was delivered without any complications. During twelve-month follow-up there was no recurrence of ventricular tachycardia or ICD interventions.ConclusionsThis case documents the first successful RFCA during ES due to recurrent unstable ventricular arrhythmias in a patient with ARVD/C in pregnancy. Current guidelines recommend metoprolol, sotalol and intravenous amiodarone for prevention of recurrent ventricular tachycardia in pregnancy, however, RFCA should be considered as a therapeutic option in selected cases. The use of 3D navigating system and near zero X-ray approach is associated with minimal radiation exposure for mother and fetus as well as low risk of procedural complication.
Highlights
Radiofrequency ablation (RFCA) became a treatment of choice in patients with recurrent ventricular tachycardia, ventricular fibrillation, and appropriate interventions of implanted cardioverter-defibrillator (ICD), electrical storm (ES) ablation in a pregnant woman has not yet been reported.Case presentation: We describe a case of a successful rescue ablation of recurrent ES in a 26-year-old Caucasian woman during her first pregnancy (23rd week)
Sotalol and intravenous amiodarone for prevention of recurrent ventricular tachycardia in pregnancy, RFCA should be considered as a therapeutic option in selected cases
Case presentation In this paper, we describe a case of recurrent ES in a 26-year-old Caucasian woman during her first pregnancy (23rd week) with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) diagnosed 3 years earlier
Summary
Improvement of RFCA with advanced modern technology should encourage the use of this method for treatment for recurrent life-threatening maternal ventricular arrhythmias or ES in pregnancy. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests The authors declare that they have no competing interests. Authors' contributions SS carried out ablation procedure and drafted the manuscript. TK was involved in ablation procedure and electroanatomical mapping with 3D mapping system. JB participated in ablation, worked with eloctrophysiological system and drafted the manuscript. PK participated in ablation was involved in drafting the manuscript and revised it critically. All authors read and approved the final manuscript
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