Abstract
Atrial fibrillation (AF) is a serious cause of morbidity and mortality in the general population, with an increasing prevalence with the improvement in diagnosis. The best current treatment approach is catheter ablation (mainly isolation of the pulmonary veins), but this is ineffective in permanent atrial fi brillation. Rate control is frequently mandatory in these patients and the most effective technique is atrioventricular node ablation. But, since this procedure renders the patient pacemaker dependent, one should be very cautious with the pacing mode selected for long-term pacing. We present the case of a 45 year-old male with permanent atrial fi brillation and drug-refractory rapid ventricular rate and tachycardia-induced cardiomyopathy, who underwent catheter ablation of the atrioventricular node and permanent selective His bundle pacing. Following the procedure, the patient went from a rapid, irregular rhythm to a controlled, regular rhythm without a change in QRS morphology. The follow-up after three months showed near complete recovery of the left ventricle and the disappearance of heart failure symptoms.
Highlights
Atrial fibrillation (AF) is a serious cause of morbidity and mortality in the general population, with an increasing prevalence with the improvement in diagnosis
The best current treatment approach is catheter ablation, but this is ineffective in permanent atrial fibrillation
Rate control is frequently mandatory in these patients and the most effective technique is atrioventricular node ablation
Summary
Atrial fibrillation (AF) is a serious cause of morbidity and mortality in the general population, with an increasing prevalence with the improvement in diagnosis. CASE REPORT A 45 year old male patient was admitted to our hospital for progressively severe shortness of breath and exercise intolerance, spanning over the last 6 months His medical history included obesity and type 2 diabetes mellitus and a diagnosis of atrial fibrillation made approximately 4 years ago. The ECG showed again atrial fibrillation with high ventricular rate despite full compliance to the atrioventricular node blocking agents. The repeat transesophageal echocardiography showed the disappearance of the left atrial appendage thrombus In this case, an electrical cardioversion was attempted. Given the echocardiographic aspect, we established the diagnosis of permanent atrial fibrillation with a probable tachycardia-induced cardiomyopathy, with a failure to control the heart rate, even with a combination of atrioventricular (AV) node blocking agents. The control echocardiography showed significant recovery of the systolic function with an ejection fraction of 50 %, a reduction in both end-diastolic and end-systolic volumes and a reduction in mitral regurgitation from moderate-severe to mild (Figure 6)
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