Zero-Fluoroscopy Catheter Ablation of Right Appendage Focal Atrial Tachycardia in a Pregnant Woman

• Published in: Clinics and practice Vol. 14; no. 3; pp. 946 - 953
• Main Authors: Troisi, Federica, Valenti, Noemi, Quadrini, Federico, Vitulano, Nicola, Di Monaco, Antonio, Romanazzi, Imma, Caruso, Rosa, Orfino, Rocco, Grimaldi, Massimo
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.06.2024; MDPI
• Subjects: Ablation; Adenosine; Antiarrhythmics; Anticoagulants; arrhythmias in pregnancy; Cardiac arrhythmia; Cardiovascular disease; Case Report; Catheters; Congenital diseases; Fetuses; Gynecology; Heart rate; Hemodynamics; Pregnancy; Radiation; right appendage; Sinuses; Thrombosis; Ultrasonic imaging; Womens health; zero-fluoroscopy ablation; United States > US; right appendage; arrhythmias in pregnancy; zero-fluoroscopy ablation
• ISSN: 2039-7275; 2039-7283; 2039-7283
• DOI: 10.3390/clinpract14030075

Arrhythmias in pregnancy are complex to manage due to the teratogenic effects of many antiarrhythmic drugs and the common use of ionizing radiation during catheter ablation procedures. Furthermore, pregnant women are extremely vulnerable and difficult to treat because of the progressive physical and hormonal changes that occur during the nine months of pregnancy. In this case report, we describe a complex clinical case of a 34-year-old pregnant woman who was affected by an incessant right atrial tachycardia, with signs and symptoms of initial hemodynamic instability. This tachycardia was refractory to antiarrhythmic drugs, so a zero-fluoroscopy ablation was performed. The first procedure was complicated by cardiac tamponade, quickly resolved without further complications for the mother or the fetus. In the following days, a deep venous thrombosis occurred at the femoral venous access. After a few days, the patient underwent a second procedure that was successful and resulted in the restoration of a sinus rhythm. The management of this clinical case was complex both from a procedural and a clinical (cardiological and gynecological) point of view. Finally, the integration of the various skills led to an excellent result.