# Management of Ablation‐Refractory Atrial Fibrillation During Pregnancy

## TL;DR

This paper discusses the rare case of a pregnant woman with ablation-refractory atrial fibrillation and the challenges in managing her condition.

## Contribution

The paper presents a novel case of ablation-refractory atrial fibrillation during pregnancy, which has not been previously reported.

## Key findings

- A 35-year-old woman experienced recurrent paroxysmal AF during her current pregnancy.
- Her AF episodes were unresponsive to previous treatment regimens, including beta-blockers.
- The patient developed syncope and persistent palpitations, leading to emergency department presentation.

## Abstract

Development of new atrial fibrillation (AF) is uncommon in pregnancy with an incidence of 0.03%. The occurrence of drug‐refractory AF during pregnancy in individuals with structurally normal hearts is even rarer, and there are no reports of ablation‐refractory AF during pregnancy in the literature. Early recognition and treatment of AF are crucial, as it causes hemodynamic changes that can adversely impact both the mother and fetus, potentially resulting in poor outcomes. We report a case of a 35‐year‐old woman at 19 weeks of gestation who presented with recurrent paroxysmal AF. Two years earlier, during her previous pregnancy, she was hospitalized for AF, where she experienced labetalol‐related hypotension and failed therapy with verapamil and digoxin. She was then managed with flecainide pill‐in‐pocket therapy until delivery. Eighteen months before this pregnancy, she underwent catheter ablation and remained stable until this current pregnancy, when she experienced 2 episodes of AF. These episodes were unresponsive to her scheduled regimen, prompting an increase in her beta‐blocker dose. However, the patient developed syncope and persistent palpitations prompting her presentation to the emergency department (ED).