Abstract
Background: Cardiac arrhythmias increasingly complicate pregnancy, affecting 68–166/100,000 pregnancy-related hospitalizations in the US, driven by advanced maternal age, congenital heart disease, and comorbidities. First-line pharmacotherapy carries risks including teratogenicity, hemodynamic disturbance, fetal growth restriction, and preterm delivery.
Aim: To assess the safety, indications, and outcomes of catheter ablation in pregnant women.
Material and Methods: PubMed and MEDLINE for catheter ablation, arrhythmia, zero fluoroscopy, antiarrhythmic drugs, physical activity in pregnancy, and cardiovascular regulation, supplemented by ESC 2025, HRS 2023, and EAPC/EHRA guidelines.
Results: Zero-fluoroscopy ablation with electroanatomical mapping is safe and effective for drug-refractory arrhythmias, hemodynamic instability, recurrent tachyarrhythmias, and arrhythmia-induced cardiomyopathy, best performed after the first trimester. Fetal adverse events were more frequent with fluoroscopy than zero-fluoroscopy (14.3% vs. 0.9%, p=0.015); procedural success exceeded 84%, with favorable neonatal outcomes.
Conclusions: In selected pregnant patients, zero-fluoroscopy ablation with Pregnancy Heart Team involvement is a safe alternative to chronic antiarrhythmic therapy and may allow faster return to physical activity, though unstudied in pregnancy. Randomized trials and standardized qualification protocols remain lacking.