Key result
Isthmus ablation restores sinus rhythm and promptly improves diuretic responsiveness in constrictive pericarditis with flutter.
Why the study?
Symptomatic improvement with targeted atrial flutter ablation in patients with constrictive pericarditis and diuretic resistant right heart failure had not been reported.
Case Report (n=1)
Restoring sinus rhythm may reestablish diuretic responsiveness in constrictive pericarditis with flutter; leaves open whether rhythm control benefits larger cohorts.
We present a 66 year old gentleman with constrictive pericarditis and persistent atrial flutter. Initial management with oral loop diuretics was successful until he developed persistent atrial flutter. Once in atrial flutter the patient developed progressive signs of right heart failure resistant to high dose intravenous loop diuretics. He was referred to a tertiary electrophysiology service where he underwent successful isthmus catheter ablation and reverted to sinus rhythm. His responsiveness to diuretics improved immediately. His symptoms improved and he was discharged 48 h later on oral diuretics. He remains well one month after discharge. This is the first reported case of symptomatic improvement in a patient with constrictive pericarditis and persistent atrial flutter with targeted treatment of the dysrhythmia. This offers a possible short-term palliation option in a group of patients where definitive surgical management carries too high a risk.
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Pittaway et al. (2015) conducted a case report in Constrictive pericarditis and persistent atrial flutter (n=1). Isthmus catheter ablation was evaluated on Symptomatic improvement and restoration of sinus rhythm. Isthmus catheter ablation successfully restored sinus rhythm and immediately improved diuretic responsiveness in a patient with constrictive pericarditis and atrial flutter.
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