Emergent catheter ablation for atrial fibrillation in a patient with acute decompensated heart failure on a mechanical haemodynamic support: a case report

BACKGROUND: 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. CASE SUMMARY: 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 The IABP and mechanical ventilation were withdrawn within a few days, and the catecholamine dose was reduced.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. DISCUSSION: 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.