Hot balloon ablation of persistent atrial fibrillation with a dilated left atrium in a case of dilated cardiomyopathy

Abstract

A 70-year-old man who developed dilated cardiomyopathy with persistent atrial fibrillation (PSAF) was admitted to our hospital. He was already drug-resistant. The left atrium (LA) was severely enlarged. The left ventricular ejection fraction (LVEF) was 39%, and contraction was severely reduced. For AF ablation, catheter ablation (CA) was used for mild to moderate LV dysfunction without severe left atrial dilatation. In severe LV dysfunction, excessive intravenous drip volume may precipitate congestive heart failure. On the other hand, shorter isolation time has been reported with balloon ablation as compared to CA. Therefore, the intravenous drip volume is small. We planned to use the balloon technique for a patient with LA dilatation and severe LV dysfunction despite another hospital not having done so. After the procedure, the pulmonary veins were successfully isolated, and congestive heart failure recovered after sinus rhythm termination. There was no recurrence of AF after the procedure. Hot balloon ablation can be effective for PSAF with severe heart failure.