Zero-X-ray catheter ablation for arrhythmias in pregnancy: acute and 24-month outcomes
A Smagulova, B Ainabekova, Z H Abdrakhmanova, Z H Suleymen, A AbdrakhmanovAbstract
Background
zero-x-ray approach is a novel method of cardiac ablation demonstrating promising safety and efficacy in general population. However, clinical data in pregnant women remain limited.
Purpose
to evaluate acute and long-term (24-mounth) outcomes of zero-x ray catheter ablation in pregnant with arrhythmias.
Methods
in this single-center prospective study, 116 pregnant with arrhythmias were enrolled (mean age 25.4±2.7 years, mean gestation age 23.2 ±2.7 weeks). Pregnancy outcomes were compared across management strategies determined by a multidisciplinary pregnancy heart team: zero-x-ray catheter ablation group (n=47) and antiarrhythmic therapy group (n=69, control).
Results
the most common arrhythmia in both groups were paroxysmal supraventricular tachycardia (24 [51%] vs. 36 [52%]) and premature contractions (20 [43%] vs. 31 [45%]), while ventricular tachycardia was rare (3 [6%] vs. 2 [3%], p=0,762). A high risk of adverse maternal cardiac events (CARPEG II score of 3) was identified in 43% (ablation group) and 49% (control group, p=0,647). Zero-x-ray catheter ablation performed under CARTO (44.7%) and Ensite Precision (55.3%) guidance and was successful in all cases (100%). One procedural complication occured (2.1%) - ileofemoral thrombosis. The subsequent course of gestation was favorable. Preeclampsia and impaired uterine blood flow were observed in both groups (4.6% vs. 2.9%, p=0.670 and 15.9% vs. 13%, p=0.234, respectively). Uterine contractile activity (4.5%) and placental abruption (2.3%) occured only after ablation (p=0,464). Term delivery was achieved in most cases (95.7% vs.96.3%, p=0.623), while one woman delivered preterm at 35 weeks (2.1%; p=0.956). Vaginal delivery predominanted (76.6% vs.84%, p=0.242). Neonatal outcomes were favorable, with normal birth weight (3207.4±485 vs. 3312.3±234.1 grams, p=0.385) and 5-minute Apgar score (8.4±1.6 vs. 8.7±1.2, p=0.467) independent of arrhythmia type or management strategy. No maternal or fetal mortality or arrhythmia recurrence was observed during the 24-mounth follow-up period.
Conclusions
zero-x-ray approach for catheter ablation in pregnancy is feasible, safe and effective, providing benign obstetric and neonatal outcomes, even in high-risk cases. A single zero-x-ray ablation procedure ensured long-term arrhythmia freedom throughout the 24 month follow-up.