Catheter ablation without fluoroscopy in pregnant with supraventricular tachycardia: substrate characterization and outcomes

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Arrhythmia is a common extra genital pathology in pregnant. Catheter ablation without fluoroscopy demonstrated similar efficacy and safety to fluoroscopy-based procedure. However, data on pregnant population is limited. PURPOSE: To evaluate the arrhythmias substrate and outcomes of catheter ablation without fluoroscopy in pregnant with supraventricular tachycardia. METHODS: 44 pregnant with drug refractory supraventricular tachycardia (Mean age 26.4±3.1 years, mean gestation age 22.8±2.1 weeks) undergoing catheter ablation. The substrate characteristics, course of pregnancy, outcomes and arrhythmia recurrence documented during 24 months follow-up. RESULTS: Ablation was performed under the guidance of CARTO (n=20; 45.5%) and EnSite NavX mapping systems (n=24; 54.5%) without fluoroscopy in all cases. In the majority of cases ablated substrate was slow conduction way (n=21, 47.7%). Ablation of accessory pathways performed in 18 pregnant (40.9%).Combination of accessory pathways with slow conduction ways was present in 5 women (11.4%). Accessory pathways located at left free wall (n=8), in right free wall (n=5), right medioseptal (n=5) and posteroseptal (n=5). The median procedural time was 71 minutes (interquartile range 60-89). Acute success rate was 100%. Procedure related complication was observed in one women (2.3%), who developed an ileofemoral thrombosis. There was no termination of pregnancy after ablation. In two women (4.5%) was preterm delivery at 35 and 36 weeks of gestation. In the majority of cases was vaginal delivery (n=35; 79.5%). In two cases were placental abruption and preeclampsia (4.5%). There were 45 live births (in one case were twins) without any malformation. Neonatal outcomes: fetal birth weight was 3198.5±542.5 grams, 5 minute Apgar score was 8.4±1.1. There were no maternal and fetal mortality. At follow up period arrhythmia recurrence was not documented. CONCLUSIONS: Pregnant mostly underwent catheter ablation for atrioventricular nodal reentrant tachycardia. Catheter ablation without fluoroscopy are safe and feasible in pregnant.