Catheter Ablation Of Arrhythmias Research Articles

Characteristics and results of catheter ablation of arrhythmias coming from the transplanted heart.

Characteristics and results of catheter ablation of arrhythmias coming from the transplanted heart.

Significant reduction of complications applying an optimized vascular access and post-interventional groin-site management during electrophysiology procedures

Abstract Background Catheter ablation of cardiac arrhythmias is an established treatment strategy. However, the optimal femoral vascular access strategy and post-interventional management in the electrophysiology (EP) setting is still under debate. Purpose To assess the impact of ultrasound-guided versus conventional femoral vascular puncture and of a modified post-interventional groin-site management strategy on complication rates. Method Patients undergoing EP procedures at the our university heart and vascular center are included in an institutional prospective registry. Conventional vascular access as well as post-interventional groin site pressure-bandage and bed rest of 6 hours (group I) was compared to a new strategy including ultrasound-guided vascular access, venous closure by a Z-suture and groin site pressure-bandage for only 2 hours plus additional 4 hours bed rest (group II). Incidences of minor and major groin site complications for both groups were compared. Hematoma, bleeding, arteriovenous fistula or pseudoaneurysm of the femoral artery without need for intervention (e.g. transfusion, thrombin injection, surgery) were classified as minor complications. Complications requiring intervention or retroperitoneal hematoma were defined as major complications. Results A total of 1535 procedures in 1381 patients (779 (51 %) procedures in 705 (51%) patients in group I and 756 (49%) procedures in 676 (49%) patients in group II) were analyzed. In group I and group II, respectively, 39%/44% procedures were index pulmonary vein isolations, 30%/29% repeat atrial fibrillation, 16 %/15% supraventricular tachycardia, 12%/11% PVC or VT ablations, and 4%/2% left atrial appendage occlusions. The total groin site complication rate was 9% (70/779 procedures) for group I, and 5% (38/756 procedures) for group II (OR 0.54 [95%-CI 0.35-0.82], p=0.003). Major groin site complications occurred in 2% (19/779 procedures) in group I and were reduced to 1% (10/756 procedures) in group II (OR 0.53 [95%-CI 0.22-1.22], p=0.156). Conclusion The overall groin site complication rate in EP-procedures was significantly reduced by implementing a novel institutional standard for vascular access management including ultrasound-guided puncture and a modified post-interventional groin site management.

Contact-force local impedance algorithm to guide effective pulmonary vein isolation in AF patients: 1-year outcome from an international multicenter clinical setting.

The combination of highly localized impedance (LI) and contact force (CF) may improve tissue characterization and lesion prediction during radiofrequency (RF) pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). We report the outcomes of our acute and long-term clinical evaluation of CF-LI-guided PVI in consecutive AF ablation cases from an international multicenter clinical setting. Three hundred twenty-four consecutive patients from 20 European centers undergoing RF catheter ablation with the Stablepoint™ catheter were enrolled in the CHARISMA registry. Of these, 275 had a minimum follow-up of 1year and were included in the primary analysis. The mean procedure duration was 115 ± 47min, and the mean fluoroscopy time was 9.9 ± 6min. At the end of the procedures, all PVs had been successfully isolated in all study patients. Minor complications were reported in 12 patients (4.4%). At 1year, 36 (13.1%) patients had had an AF recurrence, and freedom from antiarrhythmic drugs and AF recurrence was achieved in 228 (82.9%) patients. The recurrence rate was higher in patients with persistent AF (21/116, 18.1%) than in those with paroxysmal AF (15/159, 9.4%; p = 0.0459). On multivariate logistic analysis adjusted for baseline confounders, only time > 6months from first diagnosis of AF to ablation (HR = 2.93, 95%CI 1.03 to 8.36, p = 0.0459) was independently associated with recurrences. An ablation strategy for PVI guided by CF-LI technology proved safe and effective and resulted in a low recurrence rate of AF over 1-year follow-up, irrespective of the underlying AF type. Catheter Ablation of Arrhythmias with a High-Density Mapping System in Real-World Practice. (CHARISMA). URL: http://clinicaltrials.gov/ Identifier: NCT03793998.

Endocardial Pulsed Field Ablation and the Oesophagus: Are Atrio-oesophageal Fistulas Now History?

Pulsed field ablation (PFA) is a novel energy form for the catheter ablation of cardiac arrhythmias, which uses electrical fields to mediate myocardial death via irreversible electroporation and other modalities. It is believed to offer relative tissue specificity, lowering - or even eliminating - the risk of complications associated with thermal energy, such as atrio-oesophageal fistulas. The proposed superior safety profile compared to thermal ablation has contributed to the enthusiastic implementation of PFA into clinical practice and is supported by early preclinical and clinical data. However, data about the effects of PFA on the oesophagus remain limited. This organ's susceptibility to PFA has important clinical ramifications and there are two highly relevant questions. First, is the oesophagus absolutely spared by PFA or is there susceptibility to injury at higher field strengths? Second, if oesophageal injury can occur, can atrio-oesophageal fistulas ensue? The aim of this article is to provide a literature review on the effects of PFA on the oesophagus and to address these questions based on the data described.

Anatomical variation of femoral vessels and ultrasound-guided femoral vein puncture for catheter ablation of arrhythmias.

This study aims to investigate the anatomical variations in femoral vasculature and evaluate the clinical value of ultrasound-guided femoral vein puncture in catheter ablation procedures. In this retrospective analysis conducted from January 2023 to March 2023, we examined data from patients who underwent catheter ablation with ultrasound-guided femoral venipuncture. We evaluated the anatomy of the femoral vasculature at both high and low inguinal levels. Based on the relationship between the femoral vein and artery, we classified the anatomy into four types: Type I (vein parallel to artery without overlap), Type II (vein medial to artery with lumen overlap ≤50%), Type III (vein posterior to artery with lumen overlap>50%), and Type IV (vein lateral to artery). Additionally, we assessed procedure-related vascular complications that required interventions or prolonged hospital stays. A total of 254 patients were included in this study. At the upper inguinal level, most cases (92.5%) exhibited Type II, followed by Type I (6.5%), while Type III (0.6%) and IV (0.4%) were less common. At the lower inguinal level, Type II accounted for 70.7%, there was a significantly higher proportion of Type III (23.4%) and Type IV (5.9%). The overall complication rate was 0.4%, no pseudoaneurysm or hematoma was observed in our study. Our study revealed significant anatomical variations in the relationship between the femoral vein and femoral artery. Ultrasound-guided femoral venipuncture significantly reduced vascular complication rate, making it a valuable tool for guiding puncture procedures.

Emerging Tools and Techniques for Catheter Ablation of Cardiac Arrhythmias: A 2024 Update.

Emerging Tools and Techniques for Catheter Ablation of Cardiac Arrhythmias: A 2024 Update.

Best practices in robotic magnetic navigation-guided catheter ablation of cardiac arrhythmias, a position paper of the Society for Cardiac Robotic Navigation.

Robotic magnetic navigation (RMN)-guided catheter ablation (CA) technology has been used for the treatment of cardiac arrhythmias for almost 20 years. Various studies reported that RMN allows for high catheter stability, improved lesion formation and a superior safety profile. So far, no guidelines or recommendations on RMN-guided CA have been published. The aim of this consensus paper was to summarize knowledge and provide recommendations on management of arrhythmias using RMN-guided CA as treatment of atrial fibrillation (AF) and ventricular arrhythmias (VA). An expert writing group, performed a detailed review of available literature, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Recommendations on RMN-guided CA are presented in a guideline format with three levels of recommendations to serve as a reference for best practices in RMN procedures. Each recommendation is accompanied by supportive text and references. The various sections cover the practical spectrum from system and patient set-up, EP laboratory staffing, combination of RMN with fluoroscopy and mapping systems, use of automation features and ablation settings and targets, for different cardiac arrhythmias. This manuscript, presenting the combined experience of expert robotic users and knowledge from the available literature, offers a unique resource for providers interested in the use of RMN in the treatment of cardiac arrhythmias.

Major in-hospital complications after catheter ablation of cardiac arrhythmias: individual case analysis of 43 031 procedures.

In-hospital complications of catheter ablation for atrial fibrillation (AF), atrial flutter (AFL), and ventricular tachycardia (VT) may be overestimated by analyses of administrative data. We determined the incidences of in-hospital mortality, major bleeding, and stroke around AF, AFL, and VT ablations in four German tertiary centres between 2005 and 2020. All cases were coded by the G-DRG- and OPS-systems. Uniform code search terms were applied defining both the types of ablations for AF, AFL, and VT and the occurrence of major adverse events including femoral vascular complications, iatrogenic tamponade, stroke, and in-hospital death. Importantly, all complications were individually reviewed based on patient-level source records. Overall, 43 031 ablations were analysed (30 361 AF; 9364 AFL; 3306 VT). The number of ablations/year more than doubled from 2005 (n = 1569) to 2020 (n = 3317) with 3 times and 2.5 times more AF and VT ablations in 2020 (n = 2404 and n = 301, respectively) as compared to 2005 (n = 817 and n = 120, respectively), but a rather stable number of AFL ablations (n = 554 vs. n = 612). Major peri-procedural complications occurred in 594 (1.4%) patients. Complication rates were 1.1% (n = 325) for AF, 1.0% (n = 95) for AFL, and 5.3% (n = 175) for VT. With an increase in complex AF/VT procedures, the overall complication rate significantly increased (0.76% in 2005 vs. 1.81% in 2020; P = 0.004); but remained low over time. Following patient-adjudication, all in-hospital cardiac tamponades (0.7%) and strokes (0.2%) were related to ablation. Major femoral vascular complications requiring surgical intervention occurred in 0.4% of all patients. The in-hospital mortality rate adjudicated to be ablation-related was lower than the coded mortality rate: AF: 0.03% vs. 0.04%; AFL: 0.04% vs. 0.14%; VT: 0.42% vs. 1.48%. Major adverse events are low and comparable after catheter ablation for AFL and AF (∼1.0%), whereas they are five times higher for VT ablations. In the presence of an increase in complex ablation procedures, a moderate but significant increase in overall complications from 2005-20 was observed. Individual case analysis demonstrated a lower than coded ablation-related in-hospital mortality. This highlights the importance of individual case adjudication when analysing administrative data.

MT3 Intracardiac Echocardiography Operational Experience of Chinese Interventional Cardiologists in Conducting Radio-Frequency Catheter Ablation for Cardiac Arrhythmias: A Cross-Sectional Survey Study

MT3 Intracardiac Echocardiography Operational Experience of Chinese Interventional Cardiologists in Conducting Radio-Frequency Catheter Ablation for Cardiac Arrhythmias: A Cross-Sectional Survey Study

The implementation of telemedicine in the follow-up after catheter ablation of arrhythmias: do we still need in-office consultations?

The implementation of telemedicine in the follow-up after catheter ablation of arrhythmias: do we still need in-office consultations?

Case series of catheter-based arrhythmia ablation in pregnant women

Abstract Funding Acknowledgements Type of funding sources: None. Background Antiarrhythmic drugs (AADs) should be used with caution in treating arrhythmias during pregnancy because of side effects, but catheter ablation is a rarely used procedure. Aim To investigate the efficacy and safety of catheter ablation in cardiac arrhythmias during pregnancy. Methods A double-center retrospective case series study was performed. We studied a population of patients undergoing catheter ablation for cardiac arrhythmias during pregnancy between April 2014 and September 2021 in two cardiovascular centers in Hungary. Results 14 procedures [14 electrophysiology studies (EPS), 13 ablations] performed on 13 gravid women (age 30.3±5.2 years, primipara n=6) were studied. The mean gestation period was 24.0 (20.0-27.0) weeks at the time of intervention, and the mean duration of arrhythmia was 44.0±53.0 months. Of the pregnant women 38.5% had comorbidities and 15.4% had structural heart disease. During EPS, 12 patients had inducible arrhythmias. Focal atrial tachycardia was confirmed in 3, AVRT via manifest accessory pathway (AP) in 3 (WPW syndrome) AVRT via counceled AP in 1 case. AVNRT was confirmed in 3, sustained ventricular tachycardia in 2 cases (25-25-8.3-25-16.6%). 11 radiofrequency ablations (RFA) (84.6%) and 2 cryoablations (15.4%) were performed. The electroanatomical mapping system was CARTO in 11 cases (84.6%) and NavX-EnSite in 2 cases (15.4%). Intracardiac echocardiography (ICE) was used in 5 cases (38.5%). Transseptal puncture was performed in 2 cases (15.4%) due to left lateral AP. The average procedure time was 76.0±33.0 min. All the procedures (100.0%) were performed without fluoroscopy. No complications occurred during the procedures. In the long term, arrhythmia-free survival was achieved in all cases (100.0%), but in two patients, we used AADs to achieve freedom of arrhythmia. With AADs, the mean birth weight was lower than that of fetuses of gravidas not taking drugs (2110±1314 vs. 3253±458 g). APGAR was within the normal range in all cases [9.0/10.0 (IQR) (9.0-10.0/9.3-10.0)]. Conclusions Zero-fluoroscopic catheter ablation during pregnancy is an effective and safe treatment method when needed. Catheter ablation for persistent maternal arrhythmias has a more beneficial effect on fetal development than the use of AADs. Indeed, long-term outcome and safety need to be investigated in a larger patient population.

MP-453088-7 PROOF-OF-CONCEPT FORWARD-SOLUTION MAPPING OF A FOCAL ATRIAL TACHYCARDIA ORIGIN USING THE OUTPATIENT 12-LEAD ELECTROCARDIOGRAM

Arrhythmia source mapping is essential to the delivery of targeted catheter ablation for cardiac arrhythmias. Whether mapping may be performed using outpatient 12-lead electrocardiogram (ECG) data was unknown. The objective of this proof-of-concept study was to evaluate the feasibility, temporal efficiency, and accuracy for forward-solution mapping using clinical ECG data obtained outside the electrophysiology laboratory. The patient is a 24-year-old female with recurrent, symptomatic focal atrial tachycardia (focal AT) diagnosed by 12-lead ECG in the outpatient clinic. After unsuccessful medical therapy, she elected to proceed with catheter ablation at Kaiser Santa Clara Medical Center. 12-lead ECG data from the clinical ECG database (Muse, GE Medical) was exported and transferred to the forward-solution mapping system (vMap, Vektor Medical). After data upload and system confirmation of acceptable data quality, a selection window was placed around the focal AT P-wave of interest (Figure A). The mapping process was initiated and the probabilistic source locations for the focal AT were displayed by the system. These results were then compared to the results of invasive activation mapping. Results from the forward-solution analysis demonstrated a highest probability focal AT source at the anterior base of the left atrial appendage (Figure B). Total processing time following upload of the ECG data into the clinical system was less than 3 minutes. Invasive activation mapping using the electroanatomic mapping system (Carto, Biosense-Webster) also demonstrated the site of early activation at the anterior base of the left atrial appendage (Figure C). Center-to-center spatial error between the forward-solution result and the site of early activation by invasive mapping was 8.8 mm. Forward-solution arrhythmia source mapping using data from a commercial ECG system obtained outside the electrophysiology laboratory is feasible, time-efficient, and demonstrates excellent agreement with invasive electroanatomic mapping. Future studies are required to determine whether this process may facilitate the delivery of targeted arrhythmia therapy in larger populations.

PO-04-198 IMPROVED SAFETY OF CATHETER ABLATION FOR VENTRICULAR ARRHYTHMIA: A DECADES’ EXPERIENCE

Ventricular arrhythmia (VA) is a major contributor to cardiovascular morbidity and mortality. Catheter ablation is an effective therapeutic intervention for VA and has been increasingly used. Understanding the evolution of procedural risk informs risk-benefit assessment and patient selection. Examine the evolution of the safety of catheter ablation for VA. We examined our institutional experience with VA catheter ablation including premature ventricular contraction (PVC) and ventricular tachycardia (VT) ablation. A total of 2,300 patients had VA ablation over the past decade from January 2009 to October 2022. Thirty-day major complication data were obtained by individual chart review and clinical patient follow-up, and stored in our prospective institutional database. Major complications were defined as intra- or post-procedural complications leading to additional procedures or prolonged hospital stay, or post-discharge complications requiring re-hospitalization. Three time periods (2009-2013, 2014-2018 and 2019-2022) were a priori selected to examine trends in thirty-day complication outcomes. Logistic regression was implemented to test for a trend in the rate of major complications over the three time periods. In our single-center cohort, 887, 896 and 517 patients underwent catheter ablation for VA between 2009-2013, 2014-2018 and 2019-2022, respectively. We found a consistent trend of overall decreased thirty-day major complications across the three pre-defined time periods for ventricular arrhythmia catheter ablation (p=0.006). The trend of decreasing incidence of major complications persisted when we examined PVC and VT ablations separately, however, it did not reach the threshold for statistical significance (Figure 1a). The cumulative incidence of major complications in the most contemporary era was 1.3% for PVC ablation, and 2.3% for VT ablation, respectively. The decrease in major complications was primarily driven by reduction in the rate of pericardial effusion, vascular complications and thromboembolism associated with VA catheter ablation (Figure 1b). Significant strides have been made in improving the safety profile of catheter ablation for VAs. These findings may inform patient selection as the proportion of patients with ventricular arrhythmia referred for catheter ablation increases.

Long-term follow-up in preschool children after radiofrequency catheter ablation of arrhythmias.

Radiofrequency ablation (RFA) is the standard method of treatment for tachyarrhythmias in school children, and it leads to complete recovery in children without structural heart disease. However, RFA in young children is limited by the risk of complications and unstudied remote effects of radiofrequency lesions. To present the experience of RFA of arrhythmias and the results of follow-up of younger children. RFA procedures (n=255) were performed in 209 children with arrhythmias from 0 to 7 years old. The arrhythmias were presented with atrioventricular reentry tachycardia withWolff-Parkinson-White(WPW) syndrome (56%), atrial ectopic tachycardia (21.5%), atrioventricular nodal reentry tachycardia (4.8%), and ventricular arrhythmia (17.2%). The overall effectiveness of RFA, considering the repeated procedures performed due to the primary ineffectiveness and recurrencies, was 94.7%. There was no mortality associated with RFA in patients, including young patients. All cases of "major" complications are associated with RFA of the left-sided accessory pathway and tachycardia foci and are represented by the mitral valve damage in three patients (1.4%). Tachycardia and preexcitation recurred in 44 (21%) patients. There was a correlation between recurrences and parameters of RFA (odds ratio 0.894; 95% confidence interval: 0.804-0.994; p=.039). Reducing the maximum power of effective applications in our study increased the risk of recurrence. The use of the minimum effective parameters of RFA in children reduces the risk of complications, but increases arrhythmia recurrence rate.

Robotic magnetic-guided catheter ablation in patients with congenital heart disease: a systematic review and pooled analysis

ABSTRACT Background Robotic magnetic navigation (RMN) has emerged as a potential solution to overcome challenges associated with catheter ablation of arrhythmias in patients with congenital heart disease (CHD). Objectives To assess safety and efficacy of RMNguided catheter ablation in patients with CHD. Design and Methods A systematic review and pooled analysis was conducted on patients with CHD who underwent RMNguided catheter ablation. Random effects models were used to generate pooled estimates with the inverse variance method used for weighting studies. Results Twentyfour nonoverlapping records included 167 patients with CHD, mean age 36.5 years, 44.6% female. Type of CHD was simple in 27 (16.2%), moderate in 32 (19.2%), and complex in 106 (63.5%). A total of 202 procedures targeted 260 arrhythmias, the most common being macroreentrant atrial circuits. The mean procedural duration was 207.5 minutes, with a mean fluoroscopy time of 12.1 minutes. The pooled acute success rate was 89.2% [95% CI (77.8%, 97.4%)]. Freedom from arrhythmia recurrence was 84.5% [95% CI (72.5%, 94.0%)] over a mean follow-up of 24.3 months. The procedural complication rate was 3.5% with no complication attributable to RMN technology. Conclusion RMN-guided ablation appears to be safe and effective across a variety of arrhythmia substrates and types of CHD.

Long-term results of zero-fluoroscopy catheter ablation in pregnant patients with arrhythmias: a 2-year follow-up study

Abstract Funding Acknowledgements Type of funding sources: None. Background Incidences of rhythm disturbance in pregnant are commonly seen. Catheter ablation of arrhythmias has been shown to be effective and safe. Data on perinatal outcomes and results of zero-fluoroscopy catheter ablation in pregnant patients is limited. Purpose the aim of our study is to observe long-term results and perinatal outcomes in pregnant women with arrhythmias, treated by zero-fluoroscopy catheter ablation method. Methods There were 48 pregnant women, who underwent zero-fluoroscopy catheter ablation (Mean age of pregnant was 25.7±4.3 years, mean gestation age 24.1 ±3.2 weeks). Procedure-related complications, perinatal outcomes and arrhythmia recurrence were documented during 24 months follow-up. Results The most common arrhythmias were atrioventricular nodal reentrant tachycardia (n=21; 43.75%). This was followed by Wolff–Parkinson–White syndrome (n=15; 31.25%). Combination of accessory pathways with slow conduction ways were found in 3 cases (6.25%). In six cases were ablation due to frequent premature ventricular contraction (12.5%). Ventricular tachycardia was rare during pregnancy (n=3; 6.25%). Zero-fluoroscopy catheter ablation was performed under the guidance of CARTO (n=21; 43.75%) and Ensite Precision systems (n=27; 56.25%). The median procedural time was 71±15 minutes. Interventions were effective in all cases (100%). Procedural complication was in one patient (2.1%), who developed an ileofemoral thrombosis. Pregnancy course after ablation procedure was benign in all patients. Perinatal outcomes: spontaneus vaginal delivery was in the majority of cases (n=36; 75%). Twelve pregnancies (25%) were delivered by cesarean section due to obstetric indicators. Intrapartum hemorrhage was 335.2±228.92 ml. Two women had placental abraption and preeclampsia (4.2%). Maternal adverse cardiac events were none declared. There were 48 live births (in all cases). Fetal birth weight was 3324.7±684.4 grams, 5 minute Apgar was 8.4±1.3. There were no maternal and fetal mortality. At 24 months there were no arrhythmia recurrence. Conclusions Zero-fluoroscopy catheter ablation method is safe and effective in pregnant women with arrhythmias. Pregnancy course and outcomes after this procedure is bening in the majority of cases.

Ultrasound-Guided Access Reduces Vascular Complications in Patients Undergoing Catheter Ablation for Cardiac Arrhythmias.

Femoral vascular access using the standard anatomic landmark-guided method is often limited by peripheral artery disease and obesity. We investigated the effect of ultrasound-guided vascular puncture (UGVP) on the rate of vascular complications in patients undergoing catheter ablation for atrial or ventricular arrhythmias. The data of 479 patients (59% male, mean age 68 years ± 11 years) undergoing catheter ablation for left atrial (n = 426; 89%), right atrial (n = 28; 6%) or ventricular arrhythmias (n = 28; 6%) were analyzed. All patients were on uninterrupted oral anticoagulants and heparin was administered intravenously during the procedure. Femoral access complications were compared between patients undergoing UGVP (n = 320; 67%) and patients undergoing a conventional approach (n = 159; 33%). Complication rates were also compared between patients with a BMI of >30 kg/m2 (n = 136) and patients with a BMI < 30 kg/m2 (n = 343). Total vascular access complications including mild hematomas were n = 37 (7.7%). In the conventional group n = 17 (10.7%) and in the ultrasound (US) group n = 20 (6.3%) total vascular access complications occurred (OR 0.557, 95% CI 0.283-1.096). UGVP significantly reduced the risk of hematoma > 5 cm (OR 0.382, 95% CI 0.148, 0.988) or pseudoaneurysm (OR 0.160, 95% CI 0.032, 0.804). There was no significant difference between the groups regarding retroperitoneal hematomas or AV fistulas (p > 0.05). In patients with BMI > 30 kg/m2, UGVP led to a highly relevant reduction in the risk of total vascular access complications (OR 0.138, 95% CI 0.027, 0.659), hematomas > 5 cm (OR 0.051, 95% CI 0.000, 0.466) and pseudoaneurysms (OR 0.051, 95% CI 0.000, 0.466). UGVP significantly reduces vascular access complications. Patients with a BMI > 30 kg/m2 seem to particularly profit from a UGVP approach.

Feasibility of wideband dielectric imaging to guide temperature-controlled atrial fibrillation ablation.

The DiamondTemp (DT) radiofrequency (RF) ablation catheter (Medtronic, Dublin, Ireland) has been introduced for atrial fibrillation (AF) ablation. It features 6 thermocouples at its tip, imbedded in a synthetic diamond material that offers high thermal diffusivity. The technology allows temperature-controlled ablation combining high ablation power levels with a direct temperature feedback consequently resulting in homogeneous atrial lesion formation.1 Recently, a novel wideband dielectric imaging system (KODEX-EPD, EPD Solutions, Philips, Amsterdam, The Netherlands) was introduced to guide catheter ablation of cardiac arrhythmias.

Catheter ablation of sustained idiopathic right ventricular outflow tract tachycardia in a pregnant patient without fluoroscopy

In 2020, our department has performed 739 operations on nonpregnant patients. Additionally, 545 highly successful nonfluoroscopic catheter ablation of cardiac arrhythmias were routinely performed using a three-dimensional navigation system, including 47 patients with idiopathic ventricular tachycardia (VT) from the right ventricular outflow tract (RVOT).
 A 38-year-old female patient with a structurally normal heart was admitted to our hospital in 1011 weeks of her third pregnancy because she sustained recurrent 166 regular heartbeats per minute, wide QRS-complex tachycardia with left bundle branch morphology, and frequent premature ventricular contractions on Holter monitoring with complaints of presyncope and dyspnea. Standard antiarrhythmic drugs failed to control tachycardia. This case report presents our initial successful experience of the rescue zero-fluoroscopy catheter ablation of sustained poorly tolerated idiopathic RVOT tachycardia in a pregnant patient. Our result suggests that this technique may be considered in the few rare cases in which drug-resistant, sustained frequent VT is accompanied by hemodynamic compromise with fluoroscopy contraindication.
 AIM: Diagnostic algorithm of idiopathic sustained drug-resistant, poorly tolerated VT and the possibility of radiofrequency catheter ablation in the most vulnerable first trimester of pregnancy without fluoroscopy were presented in our case report.

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

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.