Non-Fluoroscopic Radiofrequency Ablation of Left Atrial Appendage Tachycardia During Early Pregnancy

Liu, Wenxiu; Qi, Shijie; Cai, Heng; Wang, Dongmei; Ru, Leisheng

doi:10.21470/1678-9741-2018-0370

Cited by 8 publications

(21 citation statements)

References 4 publications

(3 reference statements)

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“…A literature flow diagram outlining the systematic review is depicted in Figure 6. In total, 28 articles that included 30 patients were retrieved 13‐40 . The primary search via PubMed yielded 564 articles and identified nine articles for review 16,22,24‐29,33 .…”

Section: Resultsmentioning

confidence: 99%

“…Atrial overdrive pacing was performed in three patients and failed on all occasions. In one patient, atrial overdrive pacing was described as being performed through an esophageal lead that was initially placed for diagnostic purposes 39 . Direct current cardioversion was successful in 1 of 14 patients.…”

Section: Resultsmentioning

confidence: 99%

“…In the reported literature, catheter ablation was successful in 18 of the 19 (95%) patients who underwent the procedure during pregnancy, when the three patients without detailed information were added 37 . There have been nine patients with successful ablation for focal AT with zero fluoroscopy, including the case report presented in this manuscript 26,27,32,37‐39 . The one failed ablation attempt occurred in a patient where the focus was ultimately determined to be a diverticulum within the right atrial appendage 34 .…”

Section: Resultsmentioning

confidence: 99%

“…Women in the child‐bearing ages are unlikely to have permanent pacemakers. Therefore, atrial overdrive pacing would generally involve placement of an esophageal electrode 39 . Recommending an invasive procedure that is unlikely to be successful should be discouraged.…”

Section: Discussionmentioning

confidence: 99%

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Maternal focal atrial tachycardia during pregnancy: A systematic review

Wang

Shen

McLaughlin

et al. 2020

Cardiovasc electrophysiol

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Introduction The presentation and optimal management of maternal focal atrial tachycardia (AT) during pregnancy are unknown. The objective of this study is to conduct a comprehensive summary of the existing evidence. Methods and Results A systematic review of all reported cases of maternal focal AT during pregnancy was performed. The primary search queried PubMed using the MeSH terms “supraventricular tachycardia” and “pregnancy.” A stepwise ancillary search included article bibliographies, citations listed by the Google internet search engine, and PubMed using the MeSH terms “atrial tachycardia” and “pregnancy.” In total, 28 citations that described 32 patients were retrieved. A case from our institution was added. Detailed information was available for 30 patients. Clinical characteristics at presentation included a mean ± standard deviation of 28.3 ± 5.7 years for maternal age and 24.6 ± 7.7 weeks for gestation age. Suspected tachycardia‐induced cardiomyopathy was present in 20 of 30 (67%) patients and left ventricular ejection fraction improved in 15 of 15 (100%) patients with follow‐up measurements. Medication failure was common. Focal AT resolved spontaneously after delivery in eight of nine (89%) patients treated with only medications. Automaticity was suggested by discrete electrograms at sites of origin and lack of reported inducibility and termination with programmed stimulation in all patients who underwent electrophysiology studies. There were nine cases of successful catheter ablation with zero fluoroscopy since 2010. Conclusions Automaticity is the dominant mechanism for patients with maternal focal AT during pregnancy. Catheter ablation with zero fluoroscopy is an emerging therapy for medically refractory cases.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Maternal focal atrial tachycardia during pregnancy: A systematic review

Wang

Shen

McLaughlin

et al. 2020

Cardiovasc electrophysiol

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“…If ablation is required for arrhythmia control, strategies that mitigate radiation exposure are essential for both the developing fetus and the mother. There have been case studies published of successful fluoroscopy-free ablation of both supraventricular and ventricular arrhythmias during pregnancy [ 49 , 50 ].…”

Section: Unique Populationsmentioning

confidence: 99%

Into a Fluoroless Future: an Appraisal of Fluoroscopy-Free Techniques in Clinical Cardiac Electrophysiology

2021

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Purpose of Review There are risks to both patients and electrophysiology providers from radiation exposure from fluoroscopic imaging, and there is increased interest in fluoroscopic reduction. We review the imaging tools, their applications, and current uses to eliminate fluoroscopy. Recent Findings Multiple recent studies provide supporting evidence for the transition to fluoroscopy-free techniques for both ablations and device implantation. The most frequently used alternative imaging approaches include intracardiac echocardiography, cardiac MRI guidance, and 3D electroanatomic mapping systems. Electroanatomic mapping and intracardiac echocardiography originally used to augment fluoroscopy imaging are now replacing the older imaging technique. The data supports that the future of electrophysiology can be fluoroscopy-free or very low fluoroscopy for the vast majority of cases. Summary As provider and institution experience grows with these techniques, many EP labs may choose to completely forego the use of fluoroscopy. Trainees will benefit from early experience with these techniques.

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