Tobushi Tomoyuki, Sakemi Takuya, Honda Nobuhiro, Mukai Yasushi
Division of Cardiology, Japanese Red-Cross Fukuoka Hospital, 3-1-1, Okusu, Minami-ku, Fukuoka, 815-8555, Japan.
Eur Heart J Case Rep. 2021 Sep 4;5(11):ytab350. doi: 10.1093/ehjcr/ytab350. eCollection 2021 Nov.
Atrial fibrillation (AF) is associated with the exacerbation of heart failure (HF). Although AF ablation has become an established treatment for patients with HF, it is usually an elective procedure. Here, we present a case of acute decompensated heart failure (ADHF) exacerbated by refractory AF, which was successfully treated with emergent AF ablation.
A 53-year-old, obese man with a history of myocardial infarction presented to our hospital. Heart function deteriorated with an ejection fraction of 9.8%, and he was repeatedly hospitalized due to worsening HF. This time, the patient was emergently admitted due to ADHF associated with persistent AF. Atrial fibrillation was refractory to electrical cardioversion. Despite optimized medical support, the patient developed haemodynamic collapse and multiple organ failure. Intra-aortic balloon pump (IABP) and mechanical ventilation were initiated in addition to intravenous catecholamines. Emergent AF ablation was performed. Following pulmonary vein isolation, sinus rhythm was restored and the patient's haemodynamic status dramatically improved. The IABP and mechanical ventilation were withdrawn within a few days, and the catecholamine dose was reduced. After cardiac rehabilitation, the patient was discharged.
Our case suggests that an emergent AF ablation is feasible and effective even in a patient with severe ADHF. An emergent AF ablation could be a therapeutic option to treat a critically unwell patient who has deteriorated due to a vicious cycle of AF and HF.
心房颤动（AF）与心力衰竭（HF）的加重有关。尽管AF消融已成为HF患者的既定治疗方法，但它通常是一种选择性手术。在此，我们报告一例因难治性AF加重的急性失代偿性心力衰竭（ADHF）病例，该病例通过紧急AF消融成功治疗。
一名53岁、有心肌梗死病史的肥胖男性到我院就诊。心脏功能恶化，射血分数为9.8%，他因HF恶化多次住院。此次，患者因与持续性AF相关的ADHF紧急入院。房颤对电复律无效。尽管给予了优化的药物支持，患者仍出现血流动力学崩溃和多器官功能衰竭。除静脉注射儿茶酚胺外，还启动了主动脉内球囊泵（IABP）和机械通气。进行了紧急AF消融。肺静脉隔离后，恢复了窦性心律，患者的血流动力学状态显著改善。IABP和机械通气在数天内撤除，儿茶酚胺剂量减少。经过心脏康复治疗后，患者出院。
我们的病例表明，即使是重度ADHF患者，紧急AF消融也是可行且有效的。紧急AF消融可能是治疗因AF和HF恶性循环而病情恶化的危重患者的一种治疗选择。
