CONGRESS ABSTRACT

Atrial fibrillation (AF) is the most commonly cardiac arrhythmia in clinical practice with an incidence of about 1.5-2% in the general population, rising to 20% in cancer patients. The use of antiarrhythmics in patients undergoing chemotherapy, besides being less effective in maintaining sinus rhythm, leads to an increase in side effects of both drug classes. Therefore, in patients with cancer, transcatheter ablation (CA) of arrhythmia may be the effective strategy for symptom control, reduction of heart failure flare-ups and improvement of quality of life. Our clinical case concerns a 57-year-old patient suffering from dilated cardiomyopathy with severe left ventricular dysfunction (FE 25%) induced by chemotherapy treatment with anthracyclines for previous breast cancer. The patient developed persistent AF of long duration and underwent multiple ineffective attempts at pharmacological and electrical cardioversion. Despite optimised therapy, the patient has been hospitalised over the past year due to multiple episodes of heart failure flare-ups during AF with high mean ventricular response (RVM). On the occasion of the last admission, it was decided to proceed with CA. After transseptal puncture, bipolar mapping of the left atrium was performed, which showed a large area of low voltage at the level of the left pulmonary veins (PV), anterior wall of the retro-aortic portion and at the level of the inferior septum. Isolation of the VPs bilaterally and subsequent isolation of the posterior wall by means of line on the roof and floor of the left atrium and anterior mitral line was performed. A cavotricuspid line was also performed at the level of the right atrium. At the end of the procedure, effective electrical cardioversion was performed with stable RS restoration. The echocardiogram, performed at pre-discharge, showed an improvement in EF to 35%. Since then, the patient has not shown any relapses of decompensation on the basis of AF. Although to date there is a lack of studies concerning the outcome and the type of ablative strategy most suitable in this context, this clinical case reinforces the idea that CA may be a viable first-line alternative to antiarrhythmic therapy.