Radiofrequency catheter ablation of incessant atrial tachycardia in pregnant women with minimal radiation exposure: Lessons from two case studies

Abstract

During pregnancy, incessant tachyarrhythmias may result in hemodynamic compromise in both the expectant mother and the fetus. The use of antiarrhythmic drugs is typically not safe during pregnancy, and some tachycardias are refractory to pharmacologic treatment due to a significant autonomic imbalance. Catheter ablation is thought to be more effective than medical therapy, but carries the risk of radiation exposure to the fetus. We report two cases of hemodynamically unstable incessant atrial tachycardia (AT) in pregnant women. Both ATs resolved after three-dimensional electroanatomical mapping-guided radiofrequency catheter ablation with minimal fluoroscopic exposure. But one of the patients experienced a pulmonary embolism immediately after the procedure and miscarried. <Learning objective: Although catheter ablation using electroanatomical mapping is an effective treatment for incessant atrial tachycardia in pregnant women and minimizes radiation exposure to the fetus, patients should be closely monitored during the peri-procedural period due to the risk of pregnancy-associated complications such as pulmonary embolism.