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

## TL;DR

A pregnant woman with a severe heart rhythm disorder underwent a complex zero-fluoroscopy ablation procedure, which was successfully completed after initial complications.

## Contribution

This case report presents a rare and successful zero-fluoroscopy ablation in a pregnant woman with focal atrial tachycardia.

## Key findings

- Zero-fluoroscopy ablation was performed to avoid radiation exposure to the fetus.
- The procedure was complicated by cardiac tamponade and deep venous thrombosis but ultimately successful.
- Multidisciplinary collaboration was essential for managing the clinical and procedural challenges.

## Abstract

Background: 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. Case Presentation: 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. Conclusions: 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.