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Safety of Zero-Fluoroscopic Catheter Ablation During Pregnancy

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Cardiac Electrophysiology Without Fluoroscopy

Abstract

Incidence of all types of arrhythmias is higher during pregnancy, clinically significant tachyarrhythmias are rare. Since maternal tachyarrhythmias could cause hemodynamic compromise with adverse fetal complications, early recognition and effective treatment is warranted. Catheter ablation (CA) is widely regarded as the most effective treatment option for various tachyarrhythmias; however, possible procedural complications and radiation exposure that may cause harm to the mother and the fetus resulted in a hesitation to perform CA during pregnancy. Recent advances in non-fluoroscopic catheter navigation have helped minimize the radiation exposure during ablation. Although available published evidence on the safety profile and efficacy of CA without the use of fluoroscopy in comparison with anti-arrhythmic drug (AAD) therapy during pregnancy is very limited, it could lower the threshold to perform ablation in pregnant women that are not responsive to AAD therapy. Fluoroless CA could especially be utilized in pregnant patients with uncontrolled tachycardia causing hemodynamic compromise with fetal distress and in tachycardia-induced cardiomyopathy.

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References

  1. Li JM, Nguyen C, Joglar JA, Hamdan MH, Page RL. Frequency and outcome of arrhythmias complicating admission during pregnancy: experience from a high-volume and ethnically-diverse obstetric service. Clin Cardiol. 2008;31(11):538–41.

    Article  PubMed  Google Scholar 

  2. Silversides CK, Harris L, Haberer K, Sermer M, Colman JM, Siu SC. Recurrence rates of arrhythmias during pregnancy in women with previous tachyarrhythmia and impact on fetal and neonatal outcomes. Am J Cardiol. 2006;97(8):1206–12.

    Article  PubMed  Google Scholar 

  3. Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, Campbell WB, Haines DE, Kuck KH, Lerman BB, Miller DD, Shaeffer CW Jr, Stevenson WG, Tomaselli GF, Antman EM, Smith SC Jr, Alpert JS, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Hiratzka LF, Hunt SA, Jacobs AK, Russell RO Jr, Priori SG, Blanc JJ, Budaj A, Burgos EF, Cowie M, Deckers JW, Garcia MA, Klein WW, Lekakis J, Lindahl B, Mazzotta G, Morais JC, Oto A, Smiseth O, Trappe HJ, American College of Cardiology; American Heart Association Task Force on Practice Guidelines; European Society of Cardiology Committee for Practice Guidelines. Writing Committee to Develop Guidelines for the Management of Patients with Supraventricular Arrhythmias. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). Circulation. 2003;108(15):1871–909.

    Article  PubMed  Google Scholar 

  4. Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ, Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the management of patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Europace. 2015;17(11):1601–87.

    PubMed  Google Scholar 

  5. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893–962.

    Article  PubMed  Google Scholar 

  6. European Society of Gynecology (ESG); Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM), Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, Gibbs JS, Gohlke-Baerwolf C, Gorenek B, Iung B, Kirby M, Maas AH, Morais J, Nihoyannopoulos P, Pieper PG, Presbitero P, Roos-Hesselink JW, Schaufelberger M, Seeland U, Torracca L, ESC Committee for Practice Guidelines. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(24):3147–9.

    Article  Google Scholar 

  7. Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJ, van Dijk AP, Vliegen HW, Yap SC, Moons P, Ebels T, Van Veldhuisen DJ, ZAHARA Investigators. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol. 2007;49(24):2303–11.

    Article  PubMed  Google Scholar 

  8. Ueland K, Hansen JM. Maternal cardiovascular dynamics. II. Posture and uterine contractions. Am J Obstet Gynecol. 1969;103(1):1–7.

    Article  CAS  PubMed  Google Scholar 

  9. Kjeldsen J. Hemodynamic investigations during labour and delivery. Acta Obstet Gynecol Scand Suppl. 1979;89:1.

    CAS  PubMed  Google Scholar 

  10. Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, Merkely B, Pokushalov E, Sanders P, Proff J, Schunkert H, Christ H, Vogt J, Bänsch D, CASTLE-AF Investigators. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378(5):417–27.

    Article  PubMed  Google Scholar 

  11. Tung R, Vaseghi M, Frankel DS, Vergara P, Di Biase L, Nagashima K, Yu R, Vangala S, Tseng CH, Choi EK, Khurshid S, Patel M, Mathuria N, Nakahara S, Tzou WS, Sauer WH, Vakil K, Tedrow U, Burkhardt JD, Tholakanahalli VN, Saliaris A, Dickfeld T, Weiss JP, Bunch TJ, Reddy M, Kanmanthareddy A, Callans DJ, Lakkireddy D, Natale A, Marchlinski F, Stevenson WG, Della Bella P, Shivkumar K. Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: an International VT Ablation Center Collaborative Group study. Heart Rhythm. 2015;12(9):1997–2007.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ferguson JD, Helms A, Mangrum JM, DiMarco JP. Ablation of incessant left atrial tachycardia without fluoroscopy in a pregnant woman. J Cardiovasc Electrophysiol. 2011;22(3):346–9.

    Article  PubMed  Google Scholar 

  13. Leiria TL, Martins Pires L, Lapa Kruse M, Glotz de Lima G. Supraventricular tachycardia and syncope during pregnancy: a case for catheter ablation without fluoroscopy. Rev Port Cardiol. 2014;33(12):805.e1–5.

    Article  Google Scholar 

  14. Bigelow AM, Crane SS, Khoury FR, Clark JM. Catheter ablation of supraventricular tachycardia without fluoroscopy during pregnancy. Obstet Gynecol. 2015;125(6):1338–41.

    Article  PubMed  Google Scholar 

  15. Chen G, Sun G, Xu R, Chen X, Yang L, Bai Y, Yang S, Guo P, Zhang Y, Zhao C, Wang DW, Wang Y. Zero-fluoroscopy catheter ablation of severe drug-resistant arrhythmia guided by Ensite NavX system during pregnancy: two case reports and literature review. Medicine (Baltimore). 2016;95(32):e4487.

    Article  Google Scholar 

  16. Koźluk E, Piątkowska A, Kiliszek M, Lodziński P, Małkowska S, Balsam P, Rodkiewicz D, Piątkowski R, Zyśko D, Opolski G. Catheter ablation of cardiac arrhythmias in pregnancy without fluoroscopy: a case control retrospective study. Adv Clin Exp Med. 2017;26(1):129–34.

    Article  PubMed  Google Scholar 

  17. Karbarz D, Stec PJ, Deutsch K, Śledź J, Stec S. Zero-fluoroscopy catheter ablation of symptomatic pre-excitation from non-coronary cusp during pregnancy. Kardiol Pol. 2017;75(12):1351.

    Article  PubMed  Google Scholar 

  18. Prolič Kalinšek T, Jan M, Rupar K, Ražen L, Antolič B, Žižek D. Zero-fluoroscopy catheter ablation of concealed left accessory pathway in a pregnant woman. Europace. 2017;19(8):1384.

    Article  PubMed  Google Scholar 

  19. Rossi L, Penela D, Villani GQ. Intracardiac echocardiography catheter-guided zero fluoroscopy transeptal puncture technique for ablation of left-sided accessory pathway in a pregnant woman. Europace. 2017;19(11):1825.

    Article  PubMed  Google Scholar 

  20. Jan M, Ružič Medvešček N, Fabjan VV. Zero-fluoroscopy catheter ablation of focal atrial tachycardia in a pregnant woman with tachycardia induced cardiomyopathy. Zdrav Vestn. 2018;87(3–4):163–6.

    Google Scholar 

  21. Jan M, Žižek D, Rupar K, Mazić U, Kuhelj D, Lakič N, Geršak B. Fluoroless catheter ablation of various right and left sided supra-ventricular tachycardias in children and adolescents. Int J Cardiovasc Imaging. 2016;32(11):1609–16.

    Article  PubMed  Google Scholar 

  22. Stec S, Śledź J, Mazij M, Raś M, Ludwik B, Chrabąszcz M, Śledź A, Banasik M, Bzymek M, Młynarczyk K, Deutsch K, Labus M, Śpikowski J, Szydłowski L. “Feasibility of implementation of a simplified, No-X-Ray, no-lead apron, two-catheter approach” for ablation of supraventricular arrhythmias in children and adults. J Cardiovasc Electrophysiol. 2014;25(8):866–74.

    Article  PubMed  Google Scholar 

  23. Fernández-Gómez JM, Moriña-Vázquez P, Morales Edel R, Venegas-Gamero J, Barba-Pichardo R, Carranza MH. Exclusion of fluoroscopy use in catheter ablation procedures: six years of experience at a single center. J Cardiovasc Electrophysiol. 2014;25(6):638–44.

    Article  PubMed  Google Scholar 

  24. Wang Y, Chen GZ, Yao Y, Bai Y, Chu HM, Ma KZ, Liew R, Liu H, Zhong GQ, Xue YM, Wu SL, Li YF, Zhao CX, Liu QG, Lin L, Wang L, Wang DW. Ablation of idiopathic ventricular arrhythmia using zero-fluoroscopy approach with equivalent efficacy and less fatigue: a multicenter comparative study. Medicine (Baltimore). 2017;96(6):e6080.

    Article  Google Scholar 

  25. Razminia M, Willoughby MC, Demo H, Keshmiri H, Wang T, D'Silva OJ, Zheutlin TA, Jibawi H, Okhumale P, Kehoe RF. Fluoroless catheter ablation of cardiac arrhythmias: a 5-year experience. Pacing Clin Electrophysiol. 2017;40(4):425–33.

    Article  PubMed  Google Scholar 

  26. Gupta A, Perera T, Ganesan A, Sullivan T, Lau DH, Roberts-Thomson KC, Brooks AG, Sanders P. Complications of catheter ablation of atrial fibrillation: a systematic review. Circ Arrhythm Electrophysiol. 2013;6(6):1082–8.

    Article  PubMed  Google Scholar 

  27. Rodriguez-Entem FJ, Expósito V, Gonzalez-Enriquez S, Olalla-Antolin JJ. Cryoablation versus radiofrequency ablation for the treatment of atrioventricular nodal reentrant tachycardia: results of a prospective randomized study. J Interv Card Electrophysiol. 2013;36(1):41–5.

    Article  PubMed  Google Scholar 

  28. Estner HL, Ndrepepa G, Dong J, Deisenhofer I, Schreieck J, Schneider M, Plewan A, Karch M, Weyerbrock S, Wade D, Zrenner B, Schmitt C. Acute and long-term results of slow pathway ablation in patients with atrioventricular nodal reentrant tachycardia--an analysis of the predictive factors for arrhythmia recurrence. Pacing Clin Electrophysiol. 2005;28(2):102–10.

    Article  PubMed  Google Scholar 

  29. Ceresnak SR, Dubin AM, Kim JJ, Valdes SO, Fishberger SB, Shetty I, Zimmerman F, Tanel RE, Epstein MR, Motonaga KS, Capone CA, Nappo L, Gates GJ, Pass RH. Success rates in pediatric WPW ablation are improved with 3-dimensional mapping systems compared with fluoroscopy alone: a multicenter study. J Cardiovasc Electrophysiol. 2015;26(4):412–6.

    Article  PubMed  Google Scholar 

  30. Busch S, Forkmann M, Kuck KH, Lewalter T, Ince H, Straube F, Wieneke H, Julian Chun KR, Eckardt L, Schmitt C, Hochadel M, Senges J, Brachmann J. Acute and long-term outcome of focal atrial tachycardia ablation in the real world: results of the german ablation registry. Clin Res Cardiol. 2018;107(5):430–6.

    Article  PubMed  Google Scholar 

  31. Latchamsetty R, Yokokawa M, Morady F, Kim HM, Mathew S, Tilz R, Kuck KH, Nagashima K, Tedrow U, Stevenson WG, Yu R, Tung R, Shivkumar K, Sarrazin JF, Arya A, Hindricks G, Vunnam R, Dickfeld T, Daoud EG, Oza NM, Bogun F. Multicenter outcomes for catheter ablation of idiopathic premature ventricular complexes. JACC Clin Electrophysiol. 2015;1(3):116–23.

    Article  PubMed  Google Scholar 

  32. Peichl P, Wichterle D, Pavlu L, Cihak R, Aldhoon B, Kautzner J. Complications of catheter ablation of ventricular tachycardia: a single-center experience. Circ Arrhythm Electrophysiol. 2014;7(4):684–90.

    Article  PubMed  Google Scholar 

  33. Rennie J, Rosenbloom L. How long have we got to get the baby out? A review of the effects of acute and profound intrapartum hypoxia and ischaemia. Obstet Gynaecol. 2011;13:169–74.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Matevž Jan

  2. Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia

    David Žižek & Bor Antolič

  3. Department of Gynecology and Perinatology, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Vesna Fabjan Vodušek

Authors
  1. Matevž Jan
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  2. David Žižek
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  3. Vesna Fabjan Vodušek
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  4. Bor Antolič
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Editor information

Editors and Affiliations

  1. Department of Cardiac, Thoracic Vascular Sciences and Public Health, The University of Padua, Padua, Italy

    Riccardo Proietti

  2. Huazhong University of Science and Technology Tongji Hospital, Tongji Medical College, Wuhan, China

    Yan Wang

  3. Peking Union Medical College Hospital, National Center for Cardiovascular Disease, Beijing, China

    Yan Yao

  4. The First Affiliated Hospital of Guangxi Medical University , Nanning, China

    Guo Qiang Zhong

  5. Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China

    Shu Lin Wu

  6. Université de Sherbrooke , Sherbrooke, QC, Canada

    Félix Ayala-Paredes

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Jan, M., Žižek, D., Fabjan Vodušek, V., Antolič, B. (2019). Safety of Zero-Fluoroscopic Catheter Ablation During Pregnancy. In: Proietti, R., Wang, Y., Yao, Y., Zhong, G., Lin Wu, S., Ayala-Paredes, F. (eds) Cardiac Electrophysiology Without Fluoroscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-16992-3_16

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  • DOI: https://doi.org/10.1007/978-3-030-16992-3_16

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