Contemporary management of arrhythmias in pregnancy: efficacy and outcomes of catheter ablation without fluoroscopy

Ayan Suleimenovich Abdrakhmanov, Bayan A. Ainabekova, O Nuralinov, Abay Bakytzhanuly, Aliya Smagulova

2022

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DOI 10.1093/europace/euac053.073
Data confidence 70 medium
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Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart rhythm disorders are the most common cardiac complication occurring in pregnancy. Haemodynamically unstable and drug refractory arrhythmias warrant catheter ablation. However, there are little data of efficacy and outcomes of catheter ablation in pregnant women. Purpose To assess efficacy and outcomes of catheter ablation without of fluoroscopy in pregnant women. Methods This single center, prospective study included all cases of catheter ablation during gestation (n=48, study group) and pregnant women with antiarrhythmic drug therapy (n=50, control group). Complications, pregnancy course, obstetric and neonatal outcomes were determined and compared. Results The most common reported arrhythmias in both groups was supraventricular tachycardia (n=39; 81% vs n=31; 62%, p=0.045). Premature contractions was in 13% cases in study group and 32% in control group (p=0.029). Ventricular tachycardia was rare during pregnant (n=3; 6% vs n=3; 6%, p=1.0). All ablation procedures were performed without fluoroscopy (mean gestation age 24,21±3,32 weeks, mean procedural time of 71±15 minutes). In one women in study group occurred ileofemoral thrombosis, which was treated successfully. Pregnancy course was benign in all women in both group without termination. Uterine blood flow violation was in 12.5% in study group and in 8% - in control (p=0.520). Increased uterine contractility occurred only in women with catheter ablation (n=2; 4.2%, p=0.237). Type of delivery was vaginal in the majority in both groups (n=36; 75% vs n=40; 80%, p=0.553). Operative delivery was rare (n=12; 25% vs n=10; 20%, p=0.553), mainly due to obstetric indications. In 2 cases in study group were placental abraption (vs n=0, p=0.237) and preeclampsia (vs n=1; 2%, p=0.613). There were live births in all cases without maternal and fetal mortality. During 1 year follow-up there was no arrhythmia recurrence in study group. Conclusions Catheter ablation in pregnant women is safe and effective and can be performed without fluoroscopy. Majority of women with arrhythmias have benign course of pregnancy and perinatal outcomes