Non-fluoroscopic approach: a novel workflow for catheter ablation of arrhythmias in pregnant
A Smagulova, B Ainabekova, Z H Abdrakhmanova, Z H Suleymen, A AbdrakhmanovAbstract
Background
symptomatic and drug-refractory arrhythmias in pregnancy represent a challenging clinical scenario, requiring a highly specialized electrophysiological approach. Although the safety and efficacy of non-fluoroscopic catheter ablation have been well established in the general population, evidence in pregnant women remains limited.
Purpose
to evaluate the feasibility, efficacy and safety of non-fluoroscopic catheter ablation in pregnant with drug-refractory arrhythmias.
Methods
this prospective, single-center study included 47 pregnant women (mean age 25.4±2.7 years, mean gestation age 23.2 ±2.7 weeks) who underwent non-fluoroscopic catheter ablation for drug refractory arrhythmias. The mean follow-up period was 23.4 ± 2.9 months. Procedural characteristics, acute and long-term success rates, recurrence, complications, and procedure duration were analyzed, along with obstetric and neonatal outcomes.
Results
a high maternal cardiovascular risk was identified, with 9% of patients classified as mWHO 2.0 class III and 43% having a CARPEG II score of 3. All ablation procedures were performed entirely without fluoroscopy, using either CARTO (45%) or Ensite Precision (55%) electroanatomical mapping systems. The most frequent arrhythmia mechanism was atrioventricular nodal reentrant tachycardia (45%), followed by Wolff–Parkinson–White syndrome (32%; right-sided accessory pathways in 5 cases, left-sided in 8, free walls and posteroseptal in 2 cases). A combination of accessory and slow conduction pathways was found in three patients. Ventricular tachycardia (6%) and premature ventricular contractions (11%) were less common. The mean procedure time was 70.0 ± 21.4 minutes. Acute procedural success was achieved in all cases. Only one complication (2%) was observed in pregnant related to the vascular access. Pregnancy outcomes: maternal complications included placental abruption (2%), preeclampsia (5%), uterine contractile activity (5%) and impaired uterine blood flow (16%). Term delivery was achieved in 96% cases, predominantly by vaginal birth (77%) without major peripartum complication. Neonatal outcomes: all neonates had normal birth weight (3207.4±485 g) and APGAR score (8.4±1.6). No cases of maternal or fetal mortality were observed. During follow-up, arrhythmia-free survival was achieved in all cases.
Conclusions
Non-fluoroscopic catheter ablation represents a feasible, effective, and safe therapeutic option for drug-refractory arrhythmias in pregnant women, even among those with elevated maternal cardiovascular risk. This approach ensures maternal and fetal safety while eliminating radiation exposure, supporting its broader use in specialized centers.