Ablation of Severe Drug-Resistant Tachyarrhythmia During Pregnancy

作者：Szumowski Lukasz^*; Szufladowicz Ewa; Orczykowski Michal; Bodalski Robert; Derejko Pawel; Przybylski Andrzej; Urbanek Piotr; Kusmierczyk Mariusz; Kozluk Edward; Sacher Frederic; Sanders Prashanthan; Dangel Joanna; Haissaguerre Michel; Walczak Franciszek

来源：Journal of Cardiovascular Electrophysiology, 2010, 21(8): 877-882.

DOI：10.1111/j.1540-8167.2010.01727.x

• ablation
• atrioventricular (AV) node reentry
• fluoroscopy
• pregnancy
• supraventricular tachycardia
• Wolff-Parkinson-White syndrome

Ablation of Tachyarrhythmia During Pregnancy. Aims: The goal of this study was to describe mapping and ablation of severe arrhythmias during pregnancy, with minimum or no X-ray exposure. Treatment of tachyarrhythmia in pregnancy is a clinical problem. Pharmacotherapy entails a risk of adverse effects and is unsuccessful in some patients. Radiofrequency ablation has been performed rarely, because of fetal X-ray exposure and potential maternal and fetus complications.
Group and Method: Mapping and ablation was performed in 9 women (age 24-34 years) at 12-38th week of pregnancy. Three had permanent junctional reciprocating tachycardia, and 2 had incessant atrial tachycardia. Four of them had left ventricular ejection fraction <= 45%. One patient had atrioventricular nodal reciprocating tachycardia requiring cardioversion. Three patients had Wolff-Parkinson-White syndrome. Two of them had atrial fibrillation with ventricular rate 300 bpm and 1 had atrioventricular tachycardia 300 bpm.
Fetal echocardiography was performed before and after the procedure.
Results: Three women had an electroanatomic map and ablation done without X-ray exposure. The mean fluoroscopy time in the whole group was 42 +/- 37 seconds. The mean procedure time was 56 +/- 18 minutes. After the procedure, all women and fetuses were in good condition. After a mean period of 43 +/- 23 months follow up (FU), all patients were free of arrhythmia without complications related to ablation either in the mothers or children.
Conclusion: Ablation can be performed safely with no or minimal radiation exposure during pregnancy. In the setting of malignant, drug-resistant arrhythmia, ablation may be considered a therapeutic option in selected cases. (J Cardiovasc Electrophysiol, Vol. 21, pp. 877-882, August 2010)

• 出版日期2010-8
• 单位河南工业大学