Zero-fluoroscopy catheter ablation in pregnant women: outcomes and prognosis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Arrhythmias are common in pregnant. Catheter ablation is effective treatment in cases of drug refractory arrhythmias. However, data are scarce on outcomes and prognosis of catheter ablation in this population of patient. Purpose To define the cohort of pregnant undergoing for catheter ablation for arrhythmias, characterize obstetric and neonatal outcomes and prognosis. Methods This single-center, prospective study included all catheter ablation procedures for arrhythmias performed in pregnant from January 2015 until December 2019. Primary outcome was recurrence of arrhythmia. Baseline clinical characteristics, complication rates, obstetric and neonatal outcomes were also evaluated. Results In total, we included 48 patients (aged 27.04±4.32 years, mean gestation age 21.8±4.22 weeks), indicated for catheter ablation due to drug refractory arrhythmias. The most common arrhythmia was atrioventricular nodal reentrant tachycardia (n=20; 41.7%). Ablation of accessory pathways performed in 16 cases (33.3%): in left free wall (n=8), in right free wall (n=7), posteroseptal (n=1). In 3 cases was observed combination of accessory pathways with slow conduction ways. Ablation of the right ventricular outflow tract was performed in 9 cases (18.7%) of ventricular tachycardia. In all cases catheter ablation was performed successfully without fluoroscopy. One patient developed an ileofemoral thrombosis. No other complication after ablation was noted. Pregnancy course was benign in all cases without termination. Premature birth was in 2 cases at 35 and 36 weeks of gestation. Full-term pregnancy was in the majority. Preeclampsia developed in 2 pregnant women. In 75% of pregnancy was vaginal delivery, in 25% - Cesarean section. Fetal birth weight was 3226.34±623,1 grams, 5 minute Apgar was 8,92±1,8. There were 48 live births without maternal and fetal mortality. During 1 year follow-up there was no arrhythmia recurrence. Conclusions Non-fluoroscopic catheter ablation of arrhythmias in pregnant women is effective treatment options, with a high success rate, low rates of complication, favorable outcomes and prognosis.