The efficacy and safety of non-fluoroscopic catheter ablation of arrhythmias in pregnancy after mid-long-term follow-up: a single- center experience

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite the incidence of arrhythmias in pregnancy data on non-fluoroscopic catheter ablation in pregnant women and perinatal outcomes is limited. Purpose the aim of this study is to prospectively assess the efficacy and safety of non-fluoroscopic catheter ablation in pregnant women with arrhythmias. Methods 44 pregnant women (mean age of 28,2 ± 4,2 years, mean gestation age 24,4 ±3,8 weeks) indicated for catheter ablation were enrolled. The ablation was performed under the guidance of CARTO (n = 20; 45%) and Ensite Precision systems (n = 24; 55%) without fluoroscopy. Ablation characteristics, procedure-related complications and clinical outcomes were evaluated during 18 months follow-up. Results all 44 cases of ablation were successful. There were 14 (31,8%) ablation of accessory pathways - in left free wall (n = 8), in right free wall (n = 5), posteroseptal (n = 1). 19 patients (43,2%) underwent ablation for atrioventricular nodal reentrant tachycardia. In 3 cases (6,8%) were combination of accessory pathways with slow conduction ways. Ablation of the right ventricular outflow tract was performed in 8 cases (18,2%) of frequent premature ventricular contractions and idiopathic ventricular tachycardia. The median procedural time was 71 minutes (interquartile range 54-97). Procedural complication was documented in 1 patient (2,3%), who developed an ileofemoral thrombosis. Perinatal outcomes: spontaneus vaginal (n = 35; 79.5%) or vaginal-assisted (n = 4; 9.1%) delivery were in the majority. Five pregnancies (11.4%) were delivered by cesarean section. Mean median gestational age at delivery was 39 ± 1,12 weeks. In one case was placental abruption (2,3%). Maternal cardiac events was none declared. There were 44 live births (in all pregnancies). Fetal birth weight was 3324,39 ± 625,1 grams, 5 minute Apgar was 8,81 ± 1,9. There were no maternal and fetal mortality. During follow-up there were no arrhythmia recurrence. Conclusions non-fluoroscopic catheter ablation of arrhythmias is feasible and can be safety performed in pregnancy. Our data suggests that these pregnancies were with good perinatal and neonatal outcomes.