Radiofrequency ablation of incessant atrial tachycardia after COVID-19 infection

ABSTRACT

Objectives: We present a case of a 38-year-old male with no known comorbidities who presented with incessant focal atrial tachycardia complicated by tachycardia-mediated cardiomyopathy and COVID-19 infection. He successfully underwent 3D Cardiac Mapping + radiofrequency ablation of the right superior pulmonary vein. Material(s) and Method(s) Results: A 38-year-old male presented with persistent palpitations and tachycardia associated with heart failure symptoms. On work up, 12 L-ECG showed sustained focal atrial tachycardia with heart rate (HR) ranges 170-190 bpm with positive p-wave axis in lead I, II, III, AVF and upright in lead V1. He was initially started on HR-lowering medications and given electrical synchronized cardioversion which were both unsuccessful. A week later, patient developed COVID-19 pneumonia and subsequently completed isolation as per local government protocol. During the course of admission, a POCUS echocardiogram was done which showed a newly depressed left ventricular ejection fraction (EF) of 22% compared to a previous 44% two weeks earlier. Hence, patient eventually underwent successful 3D-mapping and radiofrequency ablation of the right super pulmonary vein via transseptal approach. He was then successfully discharged with Metoprolol 200 mg twice daily alongside with other heart failure medications. Conclusion(s) Development of COVID-19 infection can run the risk of worsening and clinical decompensation among patients with incessant tachyarrhythmia and there are still no established data regarding the safety of doing radiofrequency ablation post-COVID-19 infection. This case report illustrates doing a successful radiofrequency frequency ablation post-COVID-19 infection in a patient who developed incessant atrial tachycardia.