Zero-fluoroscopy trans-septal puncture and catheter ablation of a left atrial tachycardia in a pregnant woman with a prosthetic mitral valve

Ollitrault, Pierre; Pellissier, Arnaud; Ferchaud, Virginie; Havard, Justine; Champ‐Rigot, Laure; Milliez, Paul

doi:10.1093/europace/euab196

Cited by 3 publications

(12 citation statements)

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“…Therefore, there were 129 occasions in 128 patients for partly preprocedural and 128 occasions in 127 patients for all postprocedural evaluations. The articles were 23 (69.7%) case reports [ 1 , 2 , 4 , 7 , 8 , 15 – 22 , 24 , 26 – 29 , 31 – 35 ], 6 (18.2%) case series [ 11 , 13 , 14 , 30 , 36 , 37 ], 3 (9.1%) retrospective research articles [ 3 , 23 , 25 ] and 1 (3.0%) proceeding abstract [ 12 ].…”

Section: Resultsmentioning

confidence: 99%

“…Tachyarrhythmias occurred before pregnancy in 24 (42.9%) patients [ 3 , 7 , 8 , 11 , 13 , 21 , 25 , 27 – 29 , 31 , 36 ] and they occurred during pregnancy in 32 (57.1%) patients [ 2 , 3 , 14 , 16 , 17 , 19 , 24 – 26 , 30 , 33 , 35 , 37 ], whereas the onset time was unspecified for 72 patients. No difference was found in the prevalence of tachyarrhythmic onset between before and during pregnancy (χ 2 = 2.286, p = 0.093).…”

Section: Resultsmentioning

confidence: 99%

“…Among patients with an onset of tachyarrhythmias before pregnancy, the preexisting arrhythmias exacerbated after pregnancy in 7 (29.2%, 7/24) patients [ 7 , 8 , 11 , 13 , 31 , 36 ]. A previous history of ablation was recorded for 4 (3.1%, 4/128) patients [ 3 , 8 , 21 , 29 ].…”

Section: Resultsmentioning

confidence: 99%

“…An accessory pathway was identified in 28 patients: a left accessory pathway in 16 (57.1%) [ 3 , 12 – 14 , 20 , 24 , 29 , 30 , 32 ], a right accessory pathway in 10 (35.7%) [ 11 , 12 , 19 , 21 , 27 , 30 ], a posteroseptal accessory pathway in 1 (3.6%) [ 12 ] and a Coumel accessory pathway in 1 (3.6%) patient [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

“…The ablation time was recorded for 47 patients. It was performed at 23.5 ±7.8 (range: 10–38; median: 24) weeks of gestation: in the first trimester in 7 (14.9%) patients [ 3 , 7 , 13 , 15 , 22 , 26 , 30 ], in the second trimester in 23 (48.9%) patients [ 1 – 3 , 8 , 11 , 16 , 19 – 21 , 23 – 25 , 27 , 29 – 32 , 34 , 35 , 37 ] and in the third trimester in 17 (36.2%) patients [ 3 , 4 , 11 , 13 , 14 , 17 , 18 , 23 , 28 , 30 , 33 ] (χ 2 = 12.5, p = 0.002). One of the patients had ablations twice in the third trimester due to recurrence of arrhythmia after the first ablation [ 18 ].…”

Section: Resultsmentioning

confidence: 99%

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Catheter ablation for tachyarrhythmias during pregnancy

Yuan¹

2022

pwki

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Introduction: Refractory arrhythmias during pregnancy pose challenges to physicians. Aim: To give an overview of catheter ablation for tachyarrhythmias during pregnancy, and to discuss the indications of the procedure and the outcomes of both mother and fetus.Material and methods: The study materials were based on comprehensive literature retrieval of the pertinent articles published since 2000.Results: The indications for catheter ablation were refractory arrhythmias unresponsive to drug therapy in most of the cases followed by requirement of cardioversion. Atrioventricular nodal reentrant tachycardia was the most common arrhythmia developed during pregnancy. Pregnancy complications were present in 2.4% of the cases. There was no mortality among the pregnant patients. Fetal adverse events occurred in 3.1% of the cases, more in the fluoroscopy than in the zero-fluoroscopy group. The patient cohort with a radiation dose of > 50 mGy in one-third of the cases had a 14.3% fetal adverse event rate. Fetal adverse events occurred only in the second trimester, not in the other two trimesters.Conclusions: Drug-refractory and poorly tolerated tachycardias in pregnant patients warrant catheter ablation. Zero-fluoroscopy technique under guidance with three-dimensional mapping systems is preferred and strict minimal fluoroscopy is only used in extreme necessity. As ablation in the second trimester was associated with a probable higher fetal adverse event rate, it is suggested that ablation is preferably performed in the third trimester.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Catheter ablation for tachyarrhythmias during pregnancy

Yuan¹

2022

pwki

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Diagnosis and Management of Paroxysmal Supraventricular Tachycardia

Peng,

Zei

2024

JAMA

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ImportanceParoxysmal supraventricular tachycardia (PSVT), defined as tachyarrhythmias that originate from or conduct through the atria or atrioventricular node with abrupt onset, affects 168 to 332 per 100 000 individuals. Untreated PSVT is associated with adverse outcomes including high symptom burden and tachycardia-mediated cardiomyopathy.ObservationsApproximately 50% of patients with PSVT are aged 45 to 64 years and 67.5% are female. Most common symptoms include palpitations (86%), chest discomfort (47%), and dyspnea (38%). Patients may rarely develop tachycardia-mediated cardiomyopathy (1%) due to PSVT. Diagnosis is made on electrocardiogram during an arrhythmic event or using ambulatory monitoring. First-line acute therapy for hemodynamically stable patients includes vagal maneuvers such as the modified Valsalva maneuver (43% effective) and intravenous adenosine (91% effective). Emergent cardioversion is recommended for patients who are hemodynamically unstable. Catheter ablation is safe, highly effective, and recommended as first-line therapy to prevent recurrence of PSVT. Meta-analysis of observational studies shows single catheter ablation procedure success rates of 94.3% to 98.5%. Evidence is limited for the effectiveness of long-term pharmacotherapy to prevent PSVT. Nonetheless, guidelines recommend therapies including calcium channel blockers, β-blockers, and antiarrhythmic agents as management options.Conclusion and RelevanceParoxysmal SVT affects both adult and pediatric populations and is generally a benign condition. Catheter ablation is the most effective therapy to prevent recurrent PSVT. Pharmacotherapy is an important component of acute and long-term management of PSVT.

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