Successful recovery from acute decompensated heart failure associated with left ventricular diastolic dysfunction and atrial fibrillation by urgent radiofrequency catheter ablation using mechanical haemodynamic support: a case report

BACKGROUND: 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. CASE SUMMARY: 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. DISCUSSION: 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.