Posters
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Faculty
Discipline/Specialty (Author 2)
Internal Medicine
Discipline Track
Community/Public Health
Abstract
Background: The prevalence of atrial fibrillation/flutter (AF) increases with the severity of chronic heart failure (HF) and is linked to worsened outcomes and higher mortality. Implantable cardiac devices, such as the implantable cardioverter-defibrillator (ICD), reduce mortality from ventricular arrhythmias in HF patients. Conversely, AF, which occurs in up to 20% of ICD patients, can limit the clinical effectiveness of ICDs. The impact of AF on prognosis, including inappropriate ICD therapy, remains debated. This case report aims to illustrate this sporadic occurrence and discuss the controversy surrounding AF's impact on the prognosis of ICD patients.
Case Presentation: A 63-year-old male patient with systolic-diastolic HF, Paroxysmal AF, Coronary artery disease with 2 Percutaneous coronary interventions with stent placement, Peripheral artery disease, and Hypertension, was admitted due to decompensated systolic- diastolic HF with volume overload, Type II supply-demand Myocardial Infarction, non-sustained ventricular tachycardia, Paroxysmal AF with rapid ventricular response, and acute kidney injury. After stabilization of the volume overload, heart rate, acute kidney injury, and with an echocardiogram showing an ejection fraction (EF) of 30-35% with hypokinesis of the midanteroseptal and inferolateral walls, a left heart catheterization (LHC) was decided due to no previous work-up of ischemic disease after stent placements. The LHC showed a multi-vessel disease with complete in-stent restenosis distal occlusion of the Left Coronary Artery with unsuccessful cannulation attempts. The next day, the Electrophysiologist (EP) decided to perform an ICD Placement as primary prevention of sudden death in a context of persistent left ventricular dysfunction since 2023 together with history of remote myocardial infarction and low EF. Finally, the following day the EP decided to perform AF Ablation which was successful finding both, typical and atypical AF. Pt was discharged with a follow-up with the EP for the possibility of performing a pulmonary vein isolation due to Atrial Fibrillation as outpatient.
Conclusion: Atrial fibrillation (AF) can significantly impact outcomes in patients with implantable cardioverter-defibrillators (ICDs) due to poor left ventricular systolic function. Literature found that while class III anti-arrhythmic drugs reduced the incidence of inappropriate ICD therapy, they did not improve mortality rates. Consequently, restoring sinus rhythm through catheter ablation should be considered for patients with reduced LVEF, as recommended by the CASTLE AF study. The impact of AF on the prognosis of patients with ICDs remains debated. Some studies found no significant mortality difference between patients with and without AF, whereas others identified persistent AF as an independent risk factor for increased mortality within the first year of ICD therapy. AF increases the risk of death by 1.62 times and inappropriate therapy by 2.25 times post-ICD implantation. Therefore, for managing ICD patients with AF, specific ICD programming to avoid inappropriate therapy (e.g., delayed or high-rate therapy) and considering catheter ablation to improve mortality are recommended.
Presentation Type
Poster
Recommended Citation
Loayza Pintado, Jose J. and Lopez, Michelle, "Successful Typical and Atypical Atrial Flutter ablation in a Patient with Systolic-Diastolic Heart Failure and a recent Implantable Cardioverter Defibrillator: A Case Report" (2024). Research Colloquium. 61.
https://scholarworks.utrgv.edu/colloquium/2024/posters/61
Included in
Successful Typical and Atypical Atrial Flutter ablation in a Patient with Systolic-Diastolic Heart Failure and a recent Implantable Cardioverter Defibrillator: A Case Report
Background: The prevalence of atrial fibrillation/flutter (AF) increases with the severity of chronic heart failure (HF) and is linked to worsened outcomes and higher mortality. Implantable cardiac devices, such as the implantable cardioverter-defibrillator (ICD), reduce mortality from ventricular arrhythmias in HF patients. Conversely, AF, which occurs in up to 20% of ICD patients, can limit the clinical effectiveness of ICDs. The impact of AF on prognosis, including inappropriate ICD therapy, remains debated. This case report aims to illustrate this sporadic occurrence and discuss the controversy surrounding AF's impact on the prognosis of ICD patients.
Case Presentation: A 63-year-old male patient with systolic-diastolic HF, Paroxysmal AF, Coronary artery disease with 2 Percutaneous coronary interventions with stent placement, Peripheral artery disease, and Hypertension, was admitted due to decompensated systolic- diastolic HF with volume overload, Type II supply-demand Myocardial Infarction, non-sustained ventricular tachycardia, Paroxysmal AF with rapid ventricular response, and acute kidney injury. After stabilization of the volume overload, heart rate, acute kidney injury, and with an echocardiogram showing an ejection fraction (EF) of 30-35% with hypokinesis of the midanteroseptal and inferolateral walls, a left heart catheterization (LHC) was decided due to no previous work-up of ischemic disease after stent placements. The LHC showed a multi-vessel disease with complete in-stent restenosis distal occlusion of the Left Coronary Artery with unsuccessful cannulation attempts. The next day, the Electrophysiologist (EP) decided to perform an ICD Placement as primary prevention of sudden death in a context of persistent left ventricular dysfunction since 2023 together with history of remote myocardial infarction and low EF. Finally, the following day the EP decided to perform AF Ablation which was successful finding both, typical and atypical AF. Pt was discharged with a follow-up with the EP for the possibility of performing a pulmonary vein isolation due to Atrial Fibrillation as outpatient.
Conclusion: Atrial fibrillation (AF) can significantly impact outcomes in patients with implantable cardioverter-defibrillators (ICDs) due to poor left ventricular systolic function. Literature found that while class III anti-arrhythmic drugs reduced the incidence of inappropriate ICD therapy, they did not improve mortality rates. Consequently, restoring sinus rhythm through catheter ablation should be considered for patients with reduced LVEF, as recommended by the CASTLE AF study. The impact of AF on the prognosis of patients with ICDs remains debated. Some studies found no significant mortality difference between patients with and without AF, whereas others identified persistent AF as an independent risk factor for increased mortality within the first year of ICD therapy. AF increases the risk of death by 1.62 times and inappropriate therapy by 2.25 times post-ICD implantation. Therefore, for managing ICD patients with AF, specific ICD programming to avoid inappropriate therapy (e.g., delayed or high-rate therapy) and considering catheter ablation to improve mortality are recommended.