Borkowski Pawel, Nazarenko Natalia, Mangeshkar Shaunak, Borkowska Natalia, Singh Nikita, Garg Vibhor, Parker Matthew, Naser Ahmad Moayad
Internal Medicine, Albert Einstein College of Medicine, Jacobi Medical Center, New York, USA.
Pediatrics, Samodzielny Publiczny Zakład Opieki Zdrowotnej (SPZOZ), Krotoszyn, POL.
Cureus. 2023 Dec 7;15(12):e50096. doi: 10.7759/cureus.50096. eCollection 2023 Dec.
The prevalence of atrial flutter (AFL) is increasing among the elderly population, and managing this condition presents specific challenges within this demographic. As patients age, they often exhibit reduced responsiveness to conservative treatment, necessitating a more invasive approach. We present a case of a 93-year-old female who presented to the hospital with acute decompensated heart failure (ADHF) and AFL. A year prior, she was diagnosed with arrhythmia-induced cardiomyopathy. Despite recovering her ejection fraction (EF) through guideline-directed medical therapy (GDMT), her EF deteriorated again. The patient declined invasive management for her arrhythmia on multiple occasions. Managing such patients is challenging since the approach with pharmacotherapy alone often fails to maintain sinus rhythm or adequately control the ventricular rate. Growing evidence shows that invasive management, especially ablation, may be a safe and effective procedure for this patient population. Furthermore, the studies suggest that ablation may yield particular benefits for patients with simultaneous heart failure and atrial fibrillation/AFL (AF/AFL). Unfortunately, limited data exist regarding the invasive management of AFL in the elderly. Therefore, this case report aims to provide a comprehensive review of the current evidence regarding the safety and efficacy of ablation as a therapeutic option for AFL in elderly patients, with a particular focus on how patients with concomitant heart failure may benefit from ablation.
心房扑动（AFL）在老年人群中的患病率正在上升，而在这一人群中管理这种疾病存在特殊挑战。随着患者年龄增长，他们对保守治疗的反应往往会降低，需要采取更具侵入性的方法。我们报告一例93岁女性患者，因急性失代偿性心力衰竭（ADHF）和AFL入院。一年前，她被诊断为心律失常性心肌病。尽管通过指南指导的药物治疗（GDMT）恢复了射血分数（EF），但她的EF再次恶化。该患者多次拒绝针对其心律失常的侵入性治疗。管理此类患者具有挑战性，因为仅采用药物治疗往往无法维持窦性心律或充分控制心室率。越来越多的证据表明，侵入性治疗，尤其是消融术，对于这一患者群体可能是一种安全有效的方法。此外，研究表明，消融术可能对同时患有心力衰竭和心房颤动/心房扑动（AF/AFL）的患者产生特别的益处。不幸的是，关于老年患者AFL侵入性治疗的数据有限。因此，本病例报告旨在全面综述目前关于消融术作为老年患者AFL治疗选择的安全性和有效性的证据，特别关注合并心力衰竭的患者如何从消融术中获益。
