Successful recovery from acute decompensated heart failure associated with left ventricular diastolic dysfunction and atrial fibrillation by urgent radiofrequency catheter ablation using mechanical haemodynamic support: a case report

Abstract

Background Atrial fibrillation (AF) and heart failure (HF) frequently coexist and AF is associated with an exacerbation of HF. Catheter ablation (CA) of AF has proven to be an established treatment for patients with HF associated with AF. Ordinarily, CA of AF is an elective procedure. Case summary We present a 68-year-old male case with chief complaint of palpitation and general malaise, and appetite loss, associated with acute decompensated HF resulting from drug-refractory AF and left ventricular (LV) diastolic dysfunction. He underwent an urgent CA therapy for AF under mechanical support via intra-aortic balloon pumping (IABP), which dramatically improved the hemodynamic status and clinical outcomes. Discussion Despite their shared common risk factors, AF, HF, and LV diastolic dysfunction subtypes exacerbate each other and create a vicious triad of AF, HF, and LV diastolic dysfunction, developing into acute decompensated HF. Thus, it is important to overcome this vicious cycle using noninvasive and/or invasive strategies. Performing an urgent CA of AF for acute decompensated HF may be a challenging strategy and have not been well established. However, urgent CA using mechanical hemodynamic support, including IABP, might be an effective and feasible strategy in patients with medically intractable, severe ADHF associated with LVDD and drug-refractory AF as in this present case. Hemodynamically unstable patients, as in the present case, require prompt and careful monitoring of their clinical condition. Thus, it may also be important to consider the appropriate timing for optimal treatment in these patients.