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Severe Left Atrial Edema and Heart Failure After Atrial Fibrillation Ablation

2006; Lippincott Williams & Wilkins; Volume: 113; Issue: 12 Linguagem: Inglês

10.1161/circulationaha.105.562959

1524-4539

Kevin Steel, Javier Roman‐Gonzalez, Carey L. O’Bryan,

Cardiac pacing and defibrillation studies

HomeCirculationVol. 113, No. 12Severe Left Atrial Edema and Heart Failure After Atrial Fibrillation Ablation Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBSevere Left Atrial Edema and Heart Failure After Atrial Fibrillation Ablation Kevin E. Steel, Javier Roman-Gonzalez and Carey L. O'BryanIV Kevin E. SteelKevin E. Steel From the Department of Cardiology, Wilford Hall Medical Center, Lackland AFB, Tex. , Javier Roman-GonzalezJavier Roman-Gonzalez From the Department of Cardiology, Wilford Hall Medical Center, Lackland AFB, Tex. and Carey L. O'BryanIVCarey L. O'BryanIV From the Department of Cardiology, Wilford Hall Medical Center, Lackland AFB, Tex. Originally published28 Mar 2006https://doi.org/10.1161/CIRCULATIONAHA.105.562959Circulation. 2006;113:e659A 66-year-old woman with drug-refractory symptomatic paroxysmal atrial fibrillation presented for atrial fibrillation ablation. Before the procedure, she underwent a transthoracic echocardiogram and contrast-enhanced chest computed tomography (CT) scan (Figure, a) to define both her left atrial and pulmonary vein anatomy. Both structures were normal. The following day, a left atrial circumferential radiofrequency ablation throughout the atria was performed. The procedure was well tolerated, and she was discharged the following day. Two months later, the patient presented with progressive dyspnea, orthopnea, and dry cough. The ECG revealed sinus rhythm but was otherwise normal. She had an elevated pro-brain natriuretic peptide (pro-BNP) level of 562 pg/mL. A bedside transthoracic echocardiogram demonstrated a normal ejection fraction and lack of atrial mechanical systole, as shown by the absence of an A-wave on the Doppler mitral inflow pattern (Figure, b). A contrast-enhanced chest CT showed significant circumferential edema of the left atrium, large bilateral pleural effusions, and the absence of pulmonary vein stenosis (Figure, b). There were no pulmonary emboli visualized. The patient improved with aggressive diuresis and was discharged 7 days later. She has remained free of atrial fibrillation and heart failure. Six months after ablation, transthoracic echocardiography and chest CT documented a small A-wave and resolution of the left atrial edema (Figure, c). Her pro-BNP level was improved, at 95 pg/mL. Left atrial edema is a known complication of atrial fibrillation ablative procedures; however, documentation by CT scan has not been described. In this case, mechanical stunning from left atrial edema contributed to the patient's presenting symptoms and elevated pro-BNP level. Congestive heart failure associated with left atrial edema can be managed conservatively and should be considered in patients who present with congestive heart failure soon after an atrial fibrillation ablative procedure. Download figureDownload PowerPointContrast-enhanced chest CT of the left atrium with corresponding wall thickness measurements and Doppler mitral inflow patterns demonstrating normal left atrial function and anatomy before the ablative procedure (a), 2 months after the ablative procedure with associated heart failure (b), and 6 months after the ablative procedure with complete resolution of symptoms (c).DisclosuresNone.FootnotesCorrespondence to Kevin E. Steel, DO, Department of Cardiology, 759 MSGS/MCCC, 2200 Berquist Drive, Suite 1, Lackland AFB, TX 78236. 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March 28, 2006Vol 113, Issue 12 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.105.562959PMID: 16567573 Originally publishedMarch 28, 2006 PDF download Advertisement SubjectsCatheter Ablation and Implantable Cardioverter-DefibrillatorComputerized Tomography (CT)