Three-dimensional intracardiac ultrasound-guided catheter ablation for pregnancy-associated supraventricular tachycardia: a case report

BACKGROUND: Physiological changes during pregnancy increase the risk of arrhythmias, with supraventricular tachycardia (SVT) being one of the most common types. Although often benign, SVT can cause symptoms such as palpitations and dyspnea, and in severe cases, may lead to hemodynamic instability, posing risks to both the mother and fetus. Managing SVT during pregnancy is challenging due to concerns about fetal safety with medications and the limitations of interventional procedures involving radiation. This report highlights the successful treatment of pregnancy-associated SVT using three-dimensional intracardiac ultrasound-guided radiofrequency ablation, ensuring excellent outcomes for both mother and baby. CASE PRESENTATION: We report the case of a 35-year-old pregnant woman who successfully underwent zero-x-ray radiofrequency ablation (RFA) for left atrial tachycardia. At 12 weeks, sinus tachycardia was identified and treated with metoprolol, but symptoms and sustained atrial tachycardia persisted by 25 weeks. After multidisciplinary evaluation, zero-x-ray RFA was performed at 28 weeks for AVNRT, followed by a second RFA at 29 weeks to ablate tachycardia from the distal left atrial appendage. Post-procedure, symptoms resolved, and the patient delivered a healthy baby via elective cesarean at 37 weeks. Both mother and infant remained healthy at follow-up. CONCLUSION: Pregnancy complicated by SVT requires careful management due to the associated maternal and fetal risks. For patients with a history of SVT, catheter ablation prior to pregnancy is recommended to reduce recurrence and adverse outcomes. For pregnancy-onset SVT, early multidisciplinary consultation and individualized treatment are essential. Non-radiation radiofrequency ablation can be a safe and effective option in the second or third trimester to minimize fetal radiation exposure. Standardized, patient-centered management with multidisciplinary collaboration is crucial to ensuring maternal and fetal safety.