Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(8), 942–949. https://doi.org/10.1002/clc.24072 Dr. Sára Mladoniczky et al.
Points
- The study examined the use of zero-fluoroscopic catheter ablation as a treatment option for maternal arrhythmia during pregnancy.
- Data from 13 pregnant women who underwent 14 procedures were analyzed, with successful ablations performed without fluoroscopy.
- Inducible arrhythmias, including atrial tachycardia and atrioventricular re-entry tachycardia, were identified during electrophysiological studies.
- All patients achieved arrhythmia-free survival during the follow-up period, with two requiring antiarrhythmic drugs to maintain it.
- The study suggests that zero-fluoroscopic catheter ablation is a safe and effective treatment option for pregnant women with arrhythmia, potentially minimizing risks to both the mother and the fetus.
Summary
The research paper investigates the efficacy and safety of zero-fluoroscopic catheter ablation as a treatment option for maternal arrhythmia during pregnancy. The study aims to compare the outcomes of catheter ablation with medical treatment and assess its impact on fetal development.
The study analyzed data from 13 pregnant women who underwent 14 procedures (13 ablations and 14 electrophysiological studies) between April 2014 and September 2021. The demographic data revealed that the average age of the patients was 30.3±5.2 years, with six being primipara. The procedures were conducted at the Gottsegen National Cardiovascular Center and the University of Pécs Medical School, Heart Institute.
During the electrophysiological studies, 12 patients exhibited inducible arrhythmias. Expressly, atrial tachycardia was confirmed in three cases, atrioventricular re-entry tachycardia via manifest accessory pathway (AP) and via concealed AP in one case. Atrioventricular nodal re-entry tachycardia was confirmed in three cases and sustained monomorphic ventricular tachycardia in two cases. Out of the 13 ablations performed, 11 were conducted using radiofrequency ablation (84.6%), while two utilized cryoablation (15.4%). The electroanatomical mapping system was employed in all cases, and transseptal puncture was performed in two cases (15.4%) due to left lateral APs. The mean procedure time was 76.0±33.0 minutes, and all procedures were completed without fluoroscopy. No complications were reported during or after the procedures. During the follow-up period, all patients achieved arrhythmia-free survival. However, two patients required the use of antiarrhythmic drugs (AADs) to maintain this outcome. The APGAR scores, a measure of newborn well-being, were within the normal range for all cases, with a median score of 9.0/10.0 (interquartile range: 9.0–10.0/9.3–10.0).
Based on the findings, zero-fluoroscopic catheter ablation proved an effective and safe treatment option for the 13 pregnant patients included in the study. The results suggest that catheter ablation may have fewer side effects on fetal development compared to the use of antiarrhythmic drugs during pregnancy. The study highlights the potential benefits of this procedure in managing maternal arrhythmia while minimizing risks to both the mother and the fetus. Further research and larger-scale studies are warranted to validate these findings and establish zero-fluoroscopic catheter ablation as a standard treatment approach for maternal arrhythmia during pregnancy.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24072
References Mladoniczky, S., Nagy, Z., Földesi, C., Som, Z., Bálint, H. O., Környei, L., Ruzsa, D., Fődi, E., Simor, T., & Kardos, A. (2023). Case series of catheter‐based arrhythmia ablation in 13 pregnant women. Clinical Cardiology, 46(8), 942–949. https://doi.org/10.1002/clc.24072
