Electrical cardioversion and catheter ablation are safe and effective for arrhythmias in pregnant womenCatheter Ablation and Cardioversion Show Success for Pregnant Women

BackgroundDespite guideline recommendations, electrical cardioversion and catheter ablation remain underutilized for the management of pregnancy-associated arrhythmias, primarily due to persistent but unfounded safety concerns. However, delayed rhythm control may precipitate hemodynamic compromise, increasing risks of maternal cardiovascular instability and fetal distress. Herein, we report an illustrative case from our institution and provide a structured narrative review of electrical cardioversion and catheter ablation during pregnancy.MethodsWe present a case of recurrent arrhythmia in pregnancy that was refractory to standard therapies. The patient failed to respond to both radiofrequency ablation and electrical cardioversion. A search of Web of Science, Embase, and PubMed identified relevant studies using the terms pregnancy, electrical cardioversion, and catheter ablation. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) appraisal tools. The primary efficacy endpoint was successful restoration of sinus rhythm, while the safety endpoint focused on maternal-fetal adverse events.ResultsA systematic review identified 19 studies (58 patients) reporting electrical cardioversion and 44 studies (159 patients) reporting catheter ablation during pregnancy, with success rates of 89.7% and 97.5%, respectively. Among pregnant women undergoing electrical cardioversion, there were 5 cases of preterm delivery and 2 cases of maternal-fetal mortality. The catheter ablation group had 2 cases of preterm delivery with no maternal-fetal mortality. Among different arrhythmia types, atrial fibrillation was the most common in the cardioversion group, while AVNRT predominated in the catheter ablation cohort.ConclusionBoth electrical cardioversion and catheter ablation are safe and effective treatment options during pregnancy. The available clinical evidence, though largely from case reports, consistently supports their use in this patient population.