A case of ablation of idiopathic sustained ventricular tachycardia in pregnancy under fluoroscopy-free conditions using a 3D mapping system

• Published in: Journal of Japan Society of Perinatal and Neonatal Medicine Vol. 60; no. 2; pp. 292 - 297
• Main Authors: FUJII, Ayano, SUEMITSU, Tokumasa, KADOOKA, Mizuho, FURUSAWA, Yoshiaki, MIZUKAMI, Akira, MITANI, Takahiro
• Format: Journal Article
• Language: Japanese
• Published: Japan Society of Perinatal and Neonatal Medicine 2024; 一般社団法人 日本周産期・新生児医学会
• Subjects: 3D Mapping System; Catheter Ablation; Pregnancy; Ventricular Tachycardia; Zero-Fluoroscopy
• ISSN: 1348-964X; 2435-4996
• DOI: 10.34456/jjspnm.60.2_292

Arrhythmias during pregnancy tend to worsen because of increased circulating blood volume and changes in the autonomic function; hence, pre-pregnancy treatment interventions are essential. Non-sustained ventricular tachycardia without any underlying disease has a good prognosis and can be managed with pharmacological therapy. However, sustained ventricular tachycardia can lead to hemodynamic failure and ventricular fibrillation, which are life-threatening and require immediate therapeutic intervention. Ablation therapy is considered for fatal, symptomatic, and drug-resistant arrhythmias but its use is limited in pregnant women due to fetal radiation exposure. Radiation-free 3D mapping systems（3DMS）can visualize the origin and circuitry of arrhythmias by identifying their location through the magnetic field and radio frequency current. Ablation therapy using 3DMS can be performed without fluoroscopy. However, there are few reported cases of its use for ventricular tachycardia in pregnant women. We report the case of a pregnant woman with sustained ventricular tachycardia who underwent pre-pregnancy ablation; we performed 3DMS ablation in this patient at 35 weeks of gestation, considering the timing of exacerbation of sustained ventricular tachycardia, the urgency of arrhythmia, and drug resistance. We were able to complete the 3DMS procedure without any complications. The less invasive procedure, avoiding fetal radiation exposure, resulted in a good perinatal prognosis. Thus, 3DMS is a minimally invasive and effective treatment method for ventricular tachycardia, which can be safely used in pregnant women.