Authors

• Ivica Premužić Meštrović — Klinička bolnica Merkur, Zagreb, Hrvatska — ORCID: 0000-0002-2592-8302
• Matija Marković — Klinička bolnica Merkur, Zagreb, Hrvatska — ORCID: 0000-0002-2852-3730
• Ena Kurtić — Klinička bolnica Merkur, Zagreb, Hrvatska — ORCID: 0000-0001-6673-6510
• Damir Kozmar — Klinička bolnica Merkur, Zagreb, Hrvatska — ORCID: 0000-0001-7626-3534
• Mario Stipinović — Klinička bolnica Merkur, Zagreb, Hrvatska — ORCID: 0000-0002-1582-1552
• Tomislav Letilović — Klinička bolnica Merkur, Zagreb, Hrvatska — ORCID: 0000-0003-1229-7983
• Helena Jerkić — Klinička bolnica Merkur, Zagreb, Hrvatska — ORCID: 0000-0002-1650-4735
• Maro Dragičević — Klinička bolnica Merkur, Zagreb, Hrvatska
• Darko Vujanić — Klinička bolnica Merkur, Zagreb, Hrvatska — ORCID: 0000-0003-0585-5887
• Darko Počanić — Klinička bolnica Merkur, Zagreb, Hrvatska — ORCID: 0000-0003-3257-110X
• Stjepan Kranjčević — Klinička bolnica Merkur, Zagreb, Hrvatska — ORCID: 0000-0002-1575-1902

Abstract

**Introduction**: Recently published studies showed that ablation of atrial fibrillation (AF) in patients with heart failure (HF) due to tachyarrhythmia can cause recovery of systolic function and help evade HF complications (1, 2). We are describing series of patients with HF with reduced ejection fraction treated with radiofrequency (RF) ablation, whose HF was thought to be caused by tachyarrhythmia. **Case series:** 42-years-old patient with new onset HF, dilatative cardiomyopathy (LVEF 25%, NYHA III). He had no cardiovascular risk factors. Coronary artery disease (CAD) and myocarditis were excluded. Tachycardic form of AF was identified as probable cause. Patient was treated with three antiarrhythmic drugs of different class with mean heart rate of approximately 115 beats per minute (bpm). Left atrial diameter in long axis was 4.8 cm, LAVI 36mL/m2, therefore we made RF pulmonary vein isolation. On follow up patient was in sinus rhythm, and left ventricle reduced its size with complete systolic function recovery (LVEF 50%). 69-years-old patient with new onset heart failure, dilatative cardiomyopathy (LVEF 20%, NYHA II/III). Past medical history is unremarkable. At admission patient was in atrial flutter (AFL). On electrophysiology study, typical counterclockwise AFL was described and successful cavotricuspid ablation was performed. On follow up patient was in sinus rhythm with complete recovery of systolic function (LVEF 50%). 70-years-old patients with permanent AF. Recently severe reduction of systolic was noted, and AF rate was not under control despite the treatment with three antiarrhythmic drugs of different class (mean rate approximately 120 bpm). CAD was excluded. We implanted a single lead pacemaker, a subsequent AV node ablation was performed. On follow up patient is ventricularly paced 100% of time, and echocardiography showed improvement of systolic function (LVEF 45%). **Conclusion:** Heart rhythm disturbances are related to heart failure, being a cause or a consequence. Identification of arrhythmia as a causative factor of HF, and appropriate usage of ablation therapy can lead to systolic function improvement and can help evade HF complications

Keywords

cardiomyopathy, radiofrequency ablation, arrhythmia

DOI

Literature

1. Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, et al. CASTLE-AF Investigators. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med. 2018 Feb 1;378(5):417–27. https://doi.org/10.1056/NEJMoa1707855
2. Ullah W, Ling LH, Prabhu S, Lee G, Kistler P, Finlay MC, et al. Catheter ablation of atrial fibrillation in patients with heart failure. Europace. 2016 May;18(5):679–86. https://doi.org/10.1093/europace/euv440