RESUMO
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 proved 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 patient with chief complaints of palpitation and general malaise, and appetite loss, associated with acute decompensated HF (ADHF) resulting from drug-refractory AF and left ventricular (LV) diastolic dysfunction (DD). He underwent an urgent CA therapy for AF under mechanical support via intra-aortic balloon pumping (IABP), which dramatically improved his haemodynamic status and clinical outcomes. Discussion: Despite their shared common risk factors, AF, HF, and LVDD subtypes exacerbate one another and create a vicious triad of AF, HF, and LVDD, developing into ADHF. Thus, it is important to break this vicious cycle using non-invasive and/or invasive strategies. Performing an urgent CA of AF for ADHF may be a challenging strategy, which has not been well established. However, urgent CA using mechanical haemodynamic 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 the present case. Haemodynamically 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 providing optimal treatment in these patients.
RESUMO
BACKGROUND: Pulmonary vein (PV) antrum isolation (PVAI) has proven to be a useful strategy for radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) worldwide. However, non-PV foci, especially from the superior vena cava (SVC), play an important role in initiating and maintaining AF. METHODS: In all, 427 consecutive patients with non-valvular AF who were admitted to our hospitals to undergo RFCA of AF using an EnSite™ system were evaluated. The length from the top of the sinus node to the top of the myocardial sleeve of SVC (L-SVC), longer and shorter diameter of SVC of 1 cm above of junction of right atrium and SVC, and local activation time (LAT) of SVC were measured. Then, the SVC firing was evaluated by an intravenous administration of isoproterenol and adenosine triphosphate. RESULTS: L-SVC, longer and shorter diameter of SVC, and LAT of SVC were significantly longer in the SVC firing group than non-SVC firing group (P < .05). Moreover, in accordance with the L-SVC, the frequency of the SVC firing significantly increased (P < .001). A univariate analysis and multivariate statistical analysis revealed that L-SVC longer than 37.0 mm (odds ratio 6.39) and longer diameter of SVC (odds ratio 6.78) were independent risk factors for SVC firing in patients with AF who underwent RFCA of AF. CONCLUSIONS: In view of these findings, L-SVC longer than 37.0 mm longer diameter SVC longer than 17.0 mm may be one of the important predictors of SVC firing in patients with AF.
