Todoroki Wataru, Takemoto Masao, Sakai Togo, Tsuchihashi Takuya
Cardiovascular Center, Steel Memorial Yawata Hospital, 1-1-1 Haruno-machi, Yahatahigashi-ku, Kitakyushu 805-8508, Japan.
Eur Heart J Case Rep. 2023 Mar 6;7(3):ytad086. doi: 10.1093/ehjcr/ytad086. eCollection 2023 Mar.
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.
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.
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.
心房颤动（AF）与心力衰竭（HF）常并存，且AF会加重HF。AF导管消融术（CA）已被证明是治疗合并AF的HF患者的既定疗法。通常，AF的CA是一种择期手术。
我们报告一名68岁男性患者，主要症状为心悸、全身不适和食欲减退，与药物难治性AF和左心室（LV）舒张功能障碍（DD）导致的急性失代偿性HF（ADHF）有关。他在主动脉内球囊反搏（IABP）的机械支持下接受了AF的紧急CA治疗，这显著改善了他的血流动力学状态和临床结局。
尽管AF、HF和LVDD亚型有共同的危险因素，但它们会相互加重，形成AF、HF和LVDD的恶性循环，发展为ADHF。因此，使用非侵入性和/或侵入性策略打破这一恶性循环很重要。对ADHF进行AF紧急CA可能是一项具有挑战性的策略，尚未得到充分确立。然而，如本例所示，使用包括IABP在内的机械血流动力学支持进行紧急CA可能是治疗合并LVDD和药物难治性AF的药物难治性严重ADHF患者的有效且可行的策略。像本例这样血流动力学不稳定的患者需要对其临床状况进行及时、仔细的监测。因此，考虑在这些患者中提供最佳治疗的合适时机也可能很重要。
