Comparison Of Minimal Versus Zero Fluoroscopic Catheter Ablations In Gestational Supraventricular Arrhythmias

Introduction: Management of gestational supraventricular tachycardia (SVT) is challenging and requires a multidisciplinary approach for optimal management. Antiarrhythmic pharmacologic therapy has variable efficacy and carries potential risks to both mother and fetus. Catheter ablation during pregnancy has traditionally been considered a last option due to procedural safety and ionizing radiation risks. Recent advances including intracardiac echocardiography and multi-electrode electroanatomic mapping have greatly enhanced the safety and efficacy profile to successfully perform ablations with minimal to no fluoroscopy even during pregnancy; however, most of the literature publications are case reports. Though the use of fluoroscopy-guided catheter ablations for refractory cardiac arrhythmias in pregnancy have been extensively studied, there are still a paucity of data about the efficacy, safety, and aggregate outcomes of purely zero-fluoroscopic ablations in comparison to minimal fluoroscopic approaches. Methods: A literature search was performed for catheter ablations in the past fifteen years for gestational arrhythmias that used minimal or no fluoroscopy. Sixteen cases describing catheter ablations with zero-fluoroscopy were compared to twenty-four cases using minimal fluoroscopy, defined as total documented exposure time of less than 10 minutes. Baseline characteristics, techniques, and outcomes of both groups were compared. Results: Analysis of both groups demonstrated that zero-fluoroscopic approaches for treatment of gestational SVT, though underutilized, have comparable successful outcomes without additional risk compared to minimally fluoroscopic procedures. Utilization of electroanatomic mapping with or without concomitant intracardiac echocardiography in the zero-fluoroscopy group further demonstrated equal efficacy rates of successful ablation when compared to the control group. Furthermore, there were no reported immediate or long term periprocedural complications in either group, including delivery outcomes. Conclusions: Zero-fluoroscopy catheter ablation for SVT in pregnancy appears to be as effective and safe when compared to minimal fluoroscopy ablations while eliminating the theoretical risks of ionizing radiation.