Catheter Ablation of Supraventricular Tachycardia Without Fluoroscopy During Pregnancy

INTRODUCTION: Supraventricular tachycardia is relatively uncommon in pregnancy. Symptomatic arrhythmias create challenges in management during pregnancy. Catheter ablation, the usual curative treatment of choice for supraventricular tachycardia, is often deferred as a result of risks of radiation exposure to the developing fetus. Three-dimensional mapping is a new tool in cardiac electrophysiology, which is being used to eliminate fluoroscopy during catheter ablation. We report a case of successful ablation of supraventricular tachycardia during pregnancy without the use of fluoroscopy. METHODS: A 27-year-old previously healthy woman with a 22-week monozygotic twin gestation was referred for palpitations. Her initial 12-lead electrocardiogram showed supraventricular tachycardia at 185 beats per minute. An echocardiogram showed normal function with a left ventricular ejection fraction of 57%. A 24-hour Holter monitor recorded supraventricular tachycardia 50% of the time. Initial medical management with propranolol and flecainide was unsuccessful. RESULTS: An electrophysiology study was performed from the right femoral vein with catheter navigation guided by EnSite instead of fluoroscopy. This confirmed an atrioventricular nodal reentrant tachycardia, which was successfully cryoablated. The procedure was performed without fluoroscopy or sedation. There were no complications. The twins delivered at 35 weeks of gestation by cesarean. At 15 months follow-up, there has been no recurrence of supraventricular tachycardia and both twins are doing well. CONCLUSION: New tools in electrophysiology now make curative ablation procedures more readily available to pregnant women and safer for the fetus.