A case in which ablation was refractory?
Here, I am concerned about which patients with heart failure should an ablation of AF not be performed. In our institution’s cases, there were low-voltage areas in the anterior left atrium (LA) (Figure) in a patient with persistent AF and an EF of 24%. We performed an EPVI in the 1st procedure and created mitral isthmus block with a chemical ablation and performed an isolation of the posterior LA wall in the 2nd procedure 7 days after the 1st procedure. However, atrial tachycardia emerged after the EPVI and the HF did not improve. Therefore, the patient started taking amiodarone 200mg/day to maintain sinus rhythm (SR), and cardiac re-synchronized therapy (CRT) was performed. If the atrial tachycardia were to recur, we might have to perform an atrio-ventricular junctional (AVJ) ablation. We wonder whether an EPVI should be performed in this patient if an AVJ ablation must be performed.