A Case of Atrial Fibrillation With Severe Left Ventricular Dysfunction Treated With Catheter Ablation

A 61-year-old man who had a past medical history of hypertension and atrial fibrillation (AF) was referred to our hospital with orthopnea and edema in the lower extremities. Electrocardiography showed AF with a heart rate of 142 bpm. Chest radiography demonstrated cardiomegaly and bilateral pleural effusion. Transthoracic echocardiography revealed a severely reduced left ventricular (LV) systolic function (ejection fraction of 28%). He was diagnosed as acute heart failure and assessed as New York Heart Association functional class IV. Pharmacotherapy with intravenous administration of landiolol and diuretics was initiated. It was switched to oral administration of bisoprolol and diuretics after the pleural effusion diminished. The dose of bisoprolol was carefully increased over two weeks. Even after acute heart failure was compensated, his hemodynamics corresponded to Forrester subset IV. Coronary angiography was normal and the etiology of acute heart failure was considered to be hypertensive heart disease and tachycardia-induced cardiomyopathy caused by persistent AF with a rapid ventricular response from the pathological findings. Thereafter, we performed catheter ablation for the recurrent AF one month after electric shock conversion to a sinus rhythm. Some studies have reported that maintenance of a sinus rhythm benefits AF patients with severe LV dysfunction. Intensive therapy including catheter ablation might be needed for treatment of heart failure.