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Case Reports
. 2025 Aug 20;8(3):150.
doi: 10.3390/reports8030150.

A Case of Success: Guidelines-Based Treatment to Control Atrial Fibrillation-Induced Cardiomyopathy-Atrioventricular Node Ablation and Cardiac Resynchronization Therapy to the Rescue

Neda Jonaitienė  1   2 , Grytė Ramantauskaitė  1   2 , Jolanta Laukaitienė  1   2
Affiliations
Case Reports

A Case of Success: Guidelines-Based Treatment to Control Atrial Fibrillation-Induced Cardiomyopathy-Atrioventricular Node Ablation and Cardiac Resynchronization Therapy to the Rescue

Neda Jonaitienė et al. Reports (MDPI). .

Abstract

Background and Clinical Significance: Heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) frequently coexist, creating a complex clinical interplay that exacerbates morbidity and mortality. AF can directly precipitate or worsen HFrEF through mechanisms such as tachycardia-induced cardiomyopathy, loss of atrial contribution to ventricular filling, and irregular ventricular response. The use of evidence-based therapies improves clinical outcomes in patients with HFrEF. Case Presentation: We present a clinical case of a 58-year-old man with left bundle branch block (LBBB), tachysystolic AF, and the aforementioned induced HFrEF. The patient's medical treatment was optimized according to recent guidelines. Subsequent to the improvements in HF treatment, the patient's echocardiographic data showed a higher left ventricle ejection fraction (LVEF); however, it remained below 35%. Moreover, tachysystolia persisted and was not sufficiently controlled with medications. Therefore, an upgrade of the pacemaker to cardiac resynchronization therapy (CRT) following the destruction of the AV node was performed to control tachysystolic AF and worsening of HF. After the treatment adjustments, the patient's symptoms regressed, and echocardiography showed improved LVEF up to 41%. Conclusions: This case highlights the successful identification and timely application of intensive heart rate control management and heart failure induced by AF treatment.

Keywords: atrial fibrillation; heart failure; optimal treatment; reduced ejection fraction.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The timeline of the events. AF—atrial fibrillation; AV—atrioventricular; CRT-P—cardiac resynchronization therapy - pacemaker; ECS—electrocardiostimulator; EF—ejection fraction; PVI—pulmonary vein isolation; SSNS—sick sinus node syndrome.
Figure 2
Figure 2
Electrocardiogram at the time of outpatient admission. The electrocardiogram shows atrial fibrillation with QRS morphology that complies with left bundle branch block, with a QRS duration of 122 ms, an increased heart rate of about 97 bpm, and T-wave inversion in I, aVL, V5 and V6.
Figure 3
Figure 3
Electrocardiogram after CRT implantation and atrioventricular node ablation. The electrocardiogram shows atrial fibrillation, effective ventricular stimulation with a QRS duration of 162 ms, and a heart rate of 60 bpm.
Figure 4
Figure 4
The pathophysiological interaction between heart failure and atrial fibrillation. RAAS—renin–angiotensin–aldosterone system, ↑—an increase.
See this image and copyright information in PMC

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