Address for correspondence: John D. Ferguson, Cardiovascular Medicine, Department of Internal Medicine, Lee Street, University of Virginia, P.O. Box 800158, Charlottesville, VA 22908, USA. Fax: 434-924-2581; E-mail: [email protected]

Dr. Ferguson reports participation on a research grant from St. Jude Medical and compensation for participation on a speaker's bureau relevant to this topic from St. Jude Medical and Boston Scientific. Dr. Mangrum reports participation on research grants from St. Jude Medical and Boston Scientific and serving as consultant to or on the advisory board of St. Jude Medical. Other authors: No disclosures.

Abstract

Ablation Without Fluoroscopy in Pregnancy. Background: Management of symptomatic atrial arrhythmia in pregnancy remains a challenge. In this case report, a pregnant woman with incessant tachycardia underwent successful left atrial ablation. The entire procedure was performed without fluoroscopy.

Methods and Results: A 20-year-old woman, 27 weeks pregnant, was admitted with congestive cardiac failure and incessant atrial tachycardia. She had an elevated brain natriuretic peptide (BNP) and chest X-ray demonstrating heart failure. The 12-lead electrocardiogram (ECG) showed atrial tachycardia with a cycle length of 310 ms, inverted P waves in lead I and the inferior leads, and a ventricular rate of 84 bpm during 2:1 block. Echocardiogram showed a global reduction in left ventricular function with a left ventricular ejection fraction (LVEF) of 0.40. Electrical cardioversion failed. Rate control could not be achieved with beta-blockers and calcium antagonists. Amiodarone with repeat cardioversion was also unsuccessful. The patient then underwent catheter ablation. The entire procedure was performed using intracardiac echocardiography (ICE) and electroanatomical mapping with no fluoroscopy. Electrophysiology (EP) study and an activation map of the left atrium confirmed a focal left atrial tachycardia which was successfully ablated. Six weeks postablation, the left ventricular function had normalized and the patient delivered a healthy child at term, without complication.

Conclusion: Ablation of left atrial tachycardia using ICE and electroanatomical guidance is feasible in pregnant women. (J Cardiovasc Electrophysiol, Vol. 22, pp. 346-349, March 2011)

References

1 Berruezo A, Diez GR, Berne P, Esteban M, Mont L, Brugada J: Low exposure radiation with conventional guided radiofrequency catheter ablation in pregnant women. Pacing Clin Electrophysiol 2007; 30: 1299-1302.
10.1111/j.1540-8159.2007.00858.x
CAS PubMed Web of Science® Google Scholar
2 Blomstrom-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, Campbell WB, Haines DE, Kuck KH, Lerman BB, Miller DD, Shaeffer CW, 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, for the European Society of Cardiology Committee, NASPE-Heart Rhythm Society: 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) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol 2003; 42: 1493-1531.
10.1016/j.jacc.2003.08.013
PubMed Web of Science® Google Scholar
3 Grubb N, Petzer E, Lang C, Colthart A, Elhag O: A zero fuoroscopy approach for eletrophysiologic studies and catheter ablation for common supraventricular tachycardias. Heart Rhythm 2006; 3: S123.
10.1016/j.hrthm.2006.02.372
Google Scholar
4 Papagiannis J, Tsoutsinos A, Kirvassilis G, Sofianidou I, Koussi T, Laskari C, Kiaffas M, Apostolopoulou S, Rammos S: Nonfluoroscopic catheter navigation for radiofrequency catheter ablation of supraventricular tachycardia in children. Pacing Clin Electrophysiol 2006; 29: 971-978.
10.1111/j.1540-8159.2006.00472.x
CAS PubMed Web of Science® Google Scholar
5 Tuzcu V: A nonfluoroscopic approach for electrophysiology and catheter ablation procedures using a three-dimensional navigation system. Pacing Clin Electrophysiol 2007; 30: 519-525.
10.1111/j.1540-8159.2007.00702.x
CAS PubMed Web of Science® Google Scholar
6 Pachón M, Arias MA, Castellanos E, Puchol A: No fluoroscopy for cavotricuspid isthmus-dependent right atrial flutter ablation. Heart Rhythm 2009; 6: 433.
10.1016/j.hrthm.2008.07.019
PubMed Web of Science® Google Scholar
7 Smith G, Clark JM: Elimination of fluoroscopy use in a pediatric electrophysiology laboratory utilizing three-dimensional mapping. Pacing Clin Electrophysiol 2007; 30: 510-518.
10.1111/j.1540-8159.2007.00701.x
CAS PubMed Web of Science® Google Scholar
8 Clark J, Bockoven JR, Lane J, Patel CR, Smith G: Use of three-dimensional catheter guidance and trans-esophageal echocardiography to eliminate fluoroscopy in catheter ablation of left-sided accessory pathways. Pacing Clin Electrophysiol 2008; 31: 283-289.
10.1111/j.1540-8159.2008.00987.x
CAS PubMed Web of Science® Google Scholar
9 Szumowski L, Szufladowicz E, Orczykowski M, Bodalski R, Derejko P, Przybylski A, Urbanek P, Kuśmierczyk M, Koźluk E, Sacher F, Sanders P, Dangel J, Haissaguerre M, Walczak F: Ablation of severe drug-resistant tachyarrhythmia during pregnancy. J Cardiovasc Electrophysiol; DOI: 10.1111/j.1540-8167.2010.01727.x
Google Scholar

Ablation of Incessant Left Atrial Tachycardia Without Fluoroscopy in a Pregnant Woman

Abstract

References

Citing Literature