Key result
Zero-fluoroscopy catheter ablation cuts fetal adverse events by an absolute ~13% vs. conventional fluoroscopy.
Why the study?
Cardiac arrhythmias increasingly complicate pregnancy and first-line pharmacotherapy carries significant risks, necessitating assessment of catheter ablation safety and outcomes in pregnant women.
Does zero-fluoroscopy catheter ablation improve procedural safety and outcomes compared to fluoroscopy or antiarrhythmic drugs in pregnant women with cardiac arrhythmias?
Does zero-fluoroscopy catheter ablation improve procedural safety and outcomes compared to fluoroscopy or antiarrhythmic drugs in pregnant women with cardiac arrhythmias?
In selected pregnant patients, zero-fluoroscopy catheter ablation with electroanatomical mapping is a safe and effective alternative to chronic antiarrhythmic therapy, significantly reducing fetal adverse events.
May support zero-fluoroscopy ablation to limit fetal risk in pregnancy; leaves open need for prospective trials before practice change.
Background: Cardiac arrhythmias increasingly complicate pregnancy, affecting 68–166/100,000 pregnancy-related hospitalizations in the US, driven by advanced maternal age, congenital heart disease, and comorbidities. First-line pharmacotherapy carries risks including teratogenicity, hemodynamic disturbance, fetal growth restriction, and preterm delivery. Aim: To assess the safety, indications, and outcomes of catheter ablation in pregnant women. Material and Methods: PubMed and MEDLINE for catheter ablation, arrhythmia, zero fluoroscopy, antiarrhythmic drugs, physical activity in pregnancy, and cardiovascular regulation, supplemented by ESC 2025, HRS 2023, and EAPC/EHRA guidelines. Results: Zero-fluoroscopy ablation with electroanatomical mapping is safe and effective for drug-refractory arrhythmias, hemodynamic instability, recurrent tachyarrhythmias, and arrhythmia-induced cardiomyopathy, best performed after the first trimester. Fetal adverse events were more frequent with fluoroscopy than zero-fluoroscopy (14.3% vs. 0.9%, p=0.015); procedural success exceeded 84%, with favorable neonatal outcomes. Conclusions: In selected pregnant patients, zero-fluoroscopy ablation with Pregnancy Heart Team involvement is a safe alternative to chronic antiarrhythmic therapy and may allow faster return to physical activity, though unstudied in pregnancy. Randomized trials and standardized qualification protocols remain lacking.
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Jeziorowska et al. (2026) conducted a review in Cardiac arrhythmias during pregnancy. Zero-fluoroscopy catheter ablation vs. Conventional fluoroscopy ablation was evaluated on Fetal adverse events (p=0.015). Zero-fluoroscopy catheter ablation significantly reduced the rate of fetal adverse events compared to conventional fluoroscopy (0.9% vs. 14.3%, p=0.015) in pregnant women with cardiac arrhythmias.
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