Ablation of severe drug-resistant tachyarrhythmia during pregnancy

AimsThe goal of this study was to describe mapping and ablation of severe arrhythmias during pregnancy, with minimum or no X-ray exposure. Treatment of tachyarrhythmia in pregnancy is a clinical problem. Pharmacotherapy entails a risk of adverse effects and is unsuccessful in some patients. Radiofrequency ablation has been performed rarely, because of fetal X-ray exposure and potential maternal and fetus complications. GROUP AND METHOD: Mapping and ablation was performed in 9 women (age 24-34 years) at 12-38th week of pregnancy. Three had permanent junctional reciprocating tachycardia, and 2 had incessant atrial tachycardia. Four of them had left ventricular ejection fraction ResultsThree women had an electroanatomic map and ablation done without X-ray exposure. The mean fluoroscopy time in the whole group was 42 +/- 37 seconds. The mean procedure time was 56 +/- 18 minutes. After the procedure, all women and fetuses were in good condition. After a mean period of 43 +/- 23 months follow up (FU), all patients were free of arrhythmia without complications related to ablation either in the mothers or children.ConclusionAblation can be performed safely with no or minimal radiation exposure during pregnancy. In the setting of malignant, drug-resistant arrhythmia, ablation may be considered a therapeutic option in selected cases.Lukasz Szumowski, Ewa Szufladowicz, Michał Orczykowski, Robert Bodalski, Paweł Derejko, Andrzej Przybylski, Piotr Urbanek, Mariusz Ku´Smierczyk, Edward Ko´Zluk, Frederic Sacher, Prashanthan Sanders, Joanna Dangel, Michel Haissaguerre, and Franciszek Walcza

Clinical Validation and Comparison of Alternative Methods for Evaluation of Entrainment Mapping

The definitive version may be found at www.wiley.comIntroductionMeasuring the postpacing interval (PPI) and correcting for the tachycardia cycle length (TCL) is an important entrainment response (ER). However, it may be impossible to measure PPI due to electrical noise on the mapping catheter. To overcome this problem, 2 alternative methods for the assessment of ER have been proposed: N+1 difference (N+1 DIFF) and PPIR method. PPI-TCL difference (PPI-TCL) correlates very well with ER assessed by new methods, but the agreement with PPI-TCL was established only in relation to PPIR method. Moreover, it is not known which of these methods is superior in the assessment of ER.MethodsWe analyzed 155 episodes of ER in 21 patients with heterogeneous reentrant arrhythmias. ER was estimated by PPI-TCL and by both alternative methods. Agreement between methods was assessed by means of the Bland-Altman test, kappa coefficient (kappa), and correlation coefficient (r). Finally, a mathematical comparison of the alternative methods was performed.ResultsThe agreement between PPI-TCL and alternative methods was very good. For N+1 DIFF the mean difference was -1.86 +/- 7.31 ms; kappa = 0.9; r = 0.98; for PPIR method the mean difference was -1.46 +/- 7.65 ms; kappa = 0.92; r = 0.99. Agreement between both alternative methods was also very high: the mean difference of 0.5 +/- 6.6 ms; kappa = 0.89; r = 0.99. The analysis of the equations used for calculation of ER by these methods revealed that essentially they were mathematically equivalent.ConclusionEach of the alternative methods may be used for evaluation of ER when PPI-TCL cannot be assessed directly. Results obtained by both alternative methods are comparable.Pawel Derejko, Lukasz J. Szumowski, Prashanthan Sanders, Hany Dimitri, Pawel Kuklik, Andrzej Przybylski, Piotr Urbanek, Ewa Szufladowicz, Robert Bodalski, Frederic Sacher, Michel Haissaguerre and Franciszek Walcza