Lessons from timing of ablation therapy for multi-drug refractory gestational atrial tachycardia with abruptio placentae: a case report

BACKGROUND: Supraventricular tachycardia poses a clinical challenge during pregnancy, particularly if refractory to antiarrhythmic medications. Performing catheter ablation during pregnancy necessitates careful risk benefit analysis for both the mother and foetus, especially with left-sided ablations that may require post-procedural systemic anticoagulation. CASE SUMMARY: We describe a case of a 31-year-old pregnant woman with refractory atrial tachycardia which failed a multi-antiarrhythmic drug regimen and ultimately developed abruptio placentae, requiring a carefully staged ablation approach for definitive treatment. DISCUSSION: This case highlights the importance of taking into consideration the risks of post-procedural anticoagulation in the event of clinical complications in pregnancy such as abruptio placentae and coordinating carefully with gynaecologists to optimize maternal and foetal outcomes. Here, careful risk stratification was paramount to successfully navigate through the management of her atrial tachycardia while ensuring foetal viability.