Catheter ablation of sustained idiopathic right ventricular outflow tract tachycardia in a pregnant patient without fluoroscopy

In 2020, our department has performed 739 operations on nonpregnant patients. Additionally, 545 highly successful nonfluoroscopic catheter ablation of cardiac arrhythmias were routinely performed using a three-dimensional navigation system, including 47 patients with idiopathic ventricular tachycardia (VT) from the right ventricular outflow tract (RVOT).

A 38-year-old female patient with a structurally normal heart was admitted to our hospital in 10–11 weeks of her third pregnancy because she sustained recurrent 166 regular heartbeats per minute, wide QRS-complex tachycardia with left bundle branch morphology, and frequent premature ventricular contractions on Holter monitoring with complaints of presyncope and dyspnea. Standard antiarrhythmic drugs failed to control tachycardia. This case report presents our initial successful experience of the rescue zero-fluoroscopy catheter ablation of sustained poorly tolerated idiopathic RVOT tachycardia in a pregnant patient. Our result suggests that this technique may be considered in the few rare cases in which drug-resistant, sustained frequent VT is accompanied by hemodynamic compromise with fluoroscopy contraindication.

AIM: Diagnostic algorithm of idiopathic sustained drug-resistant, poorly tolerated VT and the possibility of radiofrequency catheter ablation in the most vulnerable first trimester of pregnancy without fluoroscopy were presented in our case report.