Successful fluoroless radiofrequency catheter ablation of supraventricular tachycardia during pregnancy

Kaspar, Georgy; Sanam, Kumar; Gundlapalli, Sujana; Shah, Dipak

doi:10.1002/ccr3.1623

Cited by 10 publications

(16 citation statements)

References 10 publications

(8 reference statements)

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“…For example, obese patients were shown to require nearly three times the amount of radiation exposure than what is required for nonobese patients 45 . Radiation risks are also higher for children and pregnant women 46,47 …”

Section: Discussionmentioning

confidence: 99%

The use of intracardiac echocardiography catheters in endocardial ablation of cardiac arrhythmia: Meta‐analysis of efficiency, effectiveness, and safety outcomes

Goya

Frame

Gache

et al. 2020

Cardiovasc electrophysiol

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Aims The optimal use of intracardiac echocardiography (ICE) may reduce fluoroscopy time and procedural complications during endocardial ablation of cardiac arrhythmias. Due to limited evidence in this area, we conducted the first systematic literature review and meta‐analysis to evaluate outcomes associated with the use of ICE. Methods and Results Studies reporting the use of ICE during ablation procedures vs without ICE were searched using PubMed/MEDLINE. A meta‐analysis was performed on the 19 studies (2186 patients) meeting inclusion criteria, collectively representing a broad range of arrhythmia mechanisms. Use of ICE was associated with significant reductions in fluoroscopy time (Hedges' g −1.06; 95% confidence interval [CI] −1.81 to −0.32; P < .01), fluoroscopy dose (Hedges' g −1.27; 95% CI −1.91 to −0.62; P < .01), and procedure time (Hedges' g −0.35; 95% CI −0.64 to −0.05; P = .02) vs ablation without ICE. A 6.95 minute reduction in fluoroscopy time and a 15.2 minute reduction in procedure time was observed between the ICE vs non‐ICE groups. These efficiency gains were not associated with any decreased effectiveness or safety. Sensitivity analyses limiting studies to an atrial fibrillation (AF) only population yielded similar results to the main analysis. Conclusion The use of ICE in the ablation of cardiac arrhythmias is associated with significantly lower fluoroscopy time, fluoroscopy dose, and shorter procedure time vs ablation without ICE. These efficiency improvements did not compromise the clinical effectiveness or safety of the procedure.

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Section: Discussionmentioning

confidence: 99%

The use of intracardiac echocardiography catheters in endocardial ablation of cardiac arrhythmia: Meta‐analysis of efficiency, effectiveness, and safety outcomes

Goya

Frame

Gache

et al. 2020

Cardiovasc electrophysiol

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“…In addition to atenolol, amiodarone should only be reserved for life-threatening circumstances. It is considered a class D medication and is typically used in conjunction with electric cardioversion [ 26 ]. Verapamil is a non-dihydropyridines calcium channel blocker that should be avoided in the first trimester of pregnancy because it can enter the fetal circulation and cause fetal arrhythmias such as fetal bradycardia and heart block [ 27 ].…”

Section: Reviewmentioning

confidence: 99%

“…Non-fluoroscopic ablation must be used in order to prevent any harm to the fetus. Non-fluoroscopic ablation can be achieved using three-dimensional electroanatomical mapping or intracardiac echocardiography [ 26 , 30 ].…”

Section: Reviewmentioning

confidence: 99%

“…A decapolar catheter with steerable capabilities is placed in the appropriate location within the heart. In a case study conducted by Dr. Georgy Kaspar et al, decapolar catheters were inserted into the coronary sinus and the crista terminalis of an 11-weeks pregnant female [ 26 ]. The origin of the arrhythmia was believed to be located at the crista terminalis or superior vena cava.…”

Section: Reviewmentioning

confidence: 99%

See 1 more Smart Citation

Supraventricular Tachycardia in Pregnancy: Gestational and Labor Differences in Treatment

Ibetoh¹,

Stratulat²,

Liu³

et al. 2021

Cureus

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Supraventricular tachycardia (SVT) is a tachyarrhythmia characterized by a heart rate above 120 beats per minute (BPM). Patients with SVT exhibit the following symptoms: palpitations, shortness of breath, chest pain, hemodynamic instability, or possibly asymptomatic. The increase in cardiac output and the increase in resting heart rate during pregnancy predispose pregnant women to SVT. The management of SVT in pregnancy, although remarkably similar, varies slightly based on the trimester of pregnancy. Atenolol and verapamil are effective methods of treating SVT, which can be used during the second and third trimesters. Both medications are contraindicated in the first trimester. At the same time, intravenous adenosine can be used in all three trimesters, including labor. Electrical cardioversion is an effective treatment method for hemodynamically unstable or drug-refractory patients, which has proven to be safe in all three trimesters, including labor but can result in pre-term labor in the third trimester. Non-fluoroscopic ablation proved to be the only treatment method that definitively resolved SVT without recurrence.

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“…211,212 There is growing experience in many centers with the successful use of electroanatomic mapping without fluoroscopy for arrhythmia management, if needed urgently during pregnancy. [213][214][215][216][217][218][219] In these cases, fetal cardiac monitoring has been standard of care. Collaboration with a high-risk obstetric team and neonatology should be part of procedural planning, in the unlikely event that fetal distress arises during the procedure.…”

Section: Catheter Ablation For Arrhythmias In Pregnancymentioning

confidence: 99%

Management of tachyarrhythmias in pregnancy – A review

Kugamoorthy

Spears

2020

Obstet Med

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Successful fluoroless radiofrequency catheter ablation of supraventricular tachycardia during pregnancy

Cited by 10 publications

References 10 publications

The use of intracardiac echocardiography catheters in endocardial ablation of cardiac arrhythmia: Meta‐analysis of efficiency, effectiveness, and safety outcomes

The use of intracardiac echocardiography catheters in endocardial ablation of cardiac arrhythmia: Meta‐analysis of efficiency, effectiveness, and safety outcomes

Supraventricular Tachycardia in Pregnancy: Gestational and Labor Differences in Treatment

Management of tachyarrhythmias in pregnancy – A review

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