Procedural safety and long-term outcome of zero-fluoroscopy ablation in pregnant

Abstract Background arrhythmias can occur during gestation. While in cases of drug refractory and hemodynamic instability may require catheter ablation during gestation period, the effects of this procedure on obstetric and neonatal outcomes poorly understood. Zero-fluoroscopy ablation is novel trend in arrhythmology which may reduce risk of radiation side effects in pregnant. Purpose to investigate the effectiveness and safety of zero-fluoroscopy catheter ablation in pregnant during long term follow-up. Methods in this singe center prospective study among 116 cases of arrhythmias during gestation 47 women underwent zero-fluoroscopy catheter ablation due to drug refractory (mean age 25.3±3.9 years, mean gestation age 23.7 ±3.1 weeks, main group). Data of clinical characteristics, obstetric and neonatal outcomes were analyzed and compared with control group (cases with antiarrhythmic therapy, n=69) in 24 month follow up. Results zero-fluoroscopy catheter ablation performed under the guidance of CARTO (n=21; 44.7%) and Ensite Precision systems (n=26; 55.3%) and were successful in all cases (100%). Ablation mostly performed due to atrioventricular nodal reentrant tachycardia - in 21 cases (44.7%). There were 15 cases of ablation of accessory pathways – in left (n=8), right (n=5) free walls and posteroseptal localization (n=2). In 3 cases was combination of accessory pathways with slow conduction ways (6.4%). Ablation of the right ventricular outflow tract was performed in 8 cases (17%) due to idiopathic ventricular tachycardia and premature ventricular contraction. Procedural complication was in one pregnant (2.1%), who developed an ileofemoral thrombosis. Further course of gestation showed increased uterine contractile activity and placental abruption only in main group (4.54%, p=0.464 and 2.3%, p=0.414 respectively). Uterine blood flow violation and preeclampsia were detected in both groups (15.9% vs. 13%, p=0.234 and 4.55% vs. 2.9%, p=0.670 respectively). Delivery was mostly vaginal and in term in both groups (76.6% vs.84%, p=0.242 and 95.7% vs. 96.3%, p=0.623). Neonatal outcomes was benign with live births in all cases. Fetal birth weight and 5 minute Apgar score were in normal range in both groups (3207.4±485 vs. 3312.3±234.1 grams and 8.4±1.6 vs. 8.7±1.2 respectively). Incidence of maternal and fetal mortality were not declared. There were no arrhythmia recurrence at follow up. Conclusions zero-fluoroscopy catheter ablation can be safely and effectively performed during gestation with benign obstetric and neonatal outcomes.