Successful catheter ablation of incessant atrial tachycardia in pregnancy using three‐dimensional electroanatomical mapping with minimal radiation

Abstract

Arrhythmias during pregnancy are not an infrequent problem and present a difficult therapeutic challenge to physicians. Anti-arrhythmic medication is used with some trepidation given concerns for the unborn foetus. Catheter ablation is typically avoided due to concerns regarding foetal exposure to radiation and delayed until the post-partum period. With the availability of three-dimensional mapping systems, catheter ablation may be performed with minimal radiation. We report a pregnant woman who underwent successful ablation of focal atrial tachycardia using three-dimensional electroanatomical mapping with minimal radiation exposure.

Catheter Ablation of Arrhythmia During Pregnancy

“…Sixteen published studies describing 27 separate patients undergoing catheter ablation during pregnancy were identified . All were retrospective reports, with the largest case series involving 9 patients.…”

Supraventricular tachycardia and syncope during pregnancy: A case for catheter ablation without fluoroscopy

“…5,6,7 However, the development of nonfluoroscopic mapping systems has opened up the possibility of pregnant patients undergoing invasive procedures without exposure to ionizing radiation. We recently published our experience with a zero radiation policy in our department 8 ; although there were no pregnant women in the initial series, the methodology in the case presented was exactly the same.…”

2019 APHRS expert consensus statement on three‐dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS

“…The unborn child of a pregnant women is obviously at highest risk which is why radiation exposure during pregnancy should be avoided as much as possible, but may be administered if absolutely necessary and not replaceable by a nonionizing technique . A number of groups have reported of their experience using 3D mapping systems to allow completely ZERO radiation exposure during these procedures . When transseptal access is necessary, then ICE or TEE guidance has been used mostly.…”

“…345 A number of groups have reported of their experience using 3D mapping systems to allow completely ZERO radiation exposure during these procedures. [346][347][348] When transseptal access is necessary, then ICE or TEE guidance has been used mostly. However, data from larger cohorts are missing as these cases are rare and typically present as an emergency when all pharmacologic tools have failed.…”