Key result
Among pregnant patients with focal atrial tachycardia, 67% had suspected tachycardia-induced cardiomyopathy, and zero-fluoroscopy catheter ablation was successful in 9 medically refractory cases.
Why the study?
The presentation and optimal management of maternal focal AT during pregnancy are unknown.
What are the clinical characteristics and optimal management strategies for maternal focal atrial tachycardia during pregnancy?
Systematic Review (n=33)
What are the clinical characteristics and optimal management strategies for maternal focal atrial tachycardia during pregnancy?
Maternal focal atrial tachycardia during pregnancy is frequently associated with tachycardia-induced cardiomyopathy, but LVEF typically recovers, and zero-fluoroscopy catheter ablation is an emerging therapy for medically refractory cases.
Supports zero-fluoroscopy ablation for refractory maternal focal AT; extends limited evidence on associated cardiomyopathy and LVEF recovery.
INTRODUCTION: The presentation and optimal management of maternal focal atrial tachycardia (AT) during pregnancy are unknown. The objective of this study is to conduct a comprehensive summary of the existing evidence. METHODS AND RESULTS: A systematic review of all reported cases of maternal focal AT during pregnancy was performed. The primary search queried PubMed using the MeSH terms "supraventricular tachycardia" and "pregnancy." A stepwise ancillary search included article bibliographies, citations listed by the Google internet search engine, and PubMed using the MeSH terms "atrial tachycardia" and "pregnancy." In total, 28 citations that described 32 patients were retrieved. A case from our institution was added. Detailed information was available for 30 patients. Clinical characteristics at presentation included a mean ± standard deviation of 28.3 ± 5.7 years for maternal age and 24.6 ± 7.7 weeks for gestation age. Suspected tachycardia-induced cardiomyopathy was present in 20 of 30 (67%) patients and left ventricular ejection fraction improved in 15 of 15 (100%) patients with follow-up measurements. Medication failure was common. Focal AT resolved spontaneously after delivery in eight of nine (89%) patients treated with only medications. Automaticity was suggested by discrete electrograms at sites of origin and lack of reported inducibility and termination with programmed stimulation in all patients who underwent electrophysiology studies. There were nine cases of successful catheter ablation with zero fluoroscopy since 2010. CONCLUSIONS: Automaticity is the dominant mechanism for patients with maternal focal AT during pregnancy. Catheter ablation with zero fluoroscopy is an emerging therapy for medically refractory cases.
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Wang et al. (2020) conducted a systematic review in Maternal focal atrial tachycardia during pregnancy (n=33). Medical therapy and catheter ablation was evaluated on Clinical characteristics, management, and outcomes. Among pregnant patients with focal atrial tachycardia, 67% had suspected tachycardia-induced cardiomyopathy, and zero-fluoroscopy catheter ablation was successful in 9 medically refractory cases.
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