The best practices for safety and effectiveness in pregnant: zero-fluoroscopy arrhythmias catheter ablation

Abstract

Abstract Background Arrhythmias are common during gestation. While the safety and effectiveness of zero-fluoroscopy arrhythmias catheter ablation has been studied, the effects of it in pregnant poorly understood. Purpose The aim of our single-center, prospectively study is explore feasibility, efficacy and safety of zero-fluoroscopy catheter ablation in pregnant. Methods Characteristic, obstetric and neonatal outcomes of 47 cases of zero-fluoroscopy catheter ablation during gestation (main group) within 24 month follow-up were compared with group of pregnant with antiarrhythmic therapy (control group, p=54). Ablation was performed under the guidance of CARTO (n=21; 44.7%) and Ensite Precision systems (n=26; 55.3%) and intracardiac echocardiography without using fluoroscopy in all cases. Results Mean age of pregnant and mean gestation age were comparable in both groups (25.3±3.9 vs. 27.3±3.9 years, p=0.093 and 23.7 ±3.1 vs. 23.8 ±3.2 weeks, p=0.123). Atrioventricular nodal reentrant tachycardia was the most common indications for ablation during gestation (n=21; 44.7%), which was followed by Wolff–Parkinson–White syndrome (n=15; 31.9%). Cases of combination of accessory pathways with slow conduction ways (n=3, 6.4%), ventricular tachycardia (n=3, 6.4%) and premature ventricular contraction (n=5; 10.6%) were rare. Acute procedural success of zero-fluoroscopy ablation was in 100% with mean procedural time 71.9±14.5 minutes. Complication (ileofemoral thrombosis) was in one pregnant (2.1%). Further course of pregnancy characterized by occurring increased uterine contractile activity and placental abruption only in main group (4.54%, p=0.464 and 2.3%, p=0.414 respectively), while uterine blood flow violation and preeclampsia were in both groups (15.9% vs. 13%, p=0.234 and 4.55% vs. 3.7%, p=0.730 respectively). Obstetric outcomes characterized by prevalence of vaginal delivery and delivery in term in both groups (76.6% vs.81.5%, p=0.241 and 95.7% vs. 96.3%, p=0.743). There were live births in all cases with normal range of fetal birth weight in both groups (3207.4±485 vs 3142.2±214.1 grams and 8.4±1.6 vs. 8.6±1.3 respectively). There were no incidence of mortality and arrhythmia recurrence at follow up. Conclusions Zero-fluoroscopy ablation is feasible and can be safety performed during gestation with good outcomes.