Ablation of incessant supraventricular tachycardia in pregnancy (RCD code: VIII-V-3A.O)
We present a case of a 40‑year‑old woman, 4‑months pregnant (in vitro fertilization), admitted to a hospital due to incessant supraventricular tachycardia with a rate of 187 beats/min. Attempts to stop the arrhythmia (3 × cardioversion, verapamil IV) were unsuccessful; after electrical cardioversion, tachycardia recurred after a few sinus beats. In the view of poor arrhythmia tolerance (hypotonia, dyspnea) and the risks associated with incessant tachycardia (placental hypoperfusion, development of tachyarrhythmic cardiomyopathy), it was decided to perform an electrophysiology study and ablation. The procedure was carried out with the use of a computer 3D mapping system (Ensite NavX), aiming to minimize standard fluoroscopy use. The electrophysiology study indicated the presence of focal right‑atrial tachycardia. In this situation, geometry reconstruction and activation mapping of the right atrium was carried out, localizing the arrhythmogenic focus in the inferolateral portion of the tricuspid ring. After several radiofrequency (RF) applications, arrhythmia subsided and sinus rhythm was restored. Total fluoroscopy time in the procedure was only 90 seconds; the total radiation exposure was 12mGy. In addition, the abdomen of the pregnant woman was shielded with lead gowns from both sides, thus nearly
completely eliminating the fetal radiation exposure. Unfortunately, after 4 weeks, the arrhythmia returned. A repeated ablation was carried out in an identical fashion as the index procedure, again with only minimal fluoroscopy time (62 s, 10mGy). The rest of pregnancy and labour were uneventful, without recurrence of tachycardia and a healthy baby was delivered. Therapeutic options and literature are reviewed and discussed. JRCD 2013; 1 (4): 24–28
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