Congestive heart failure after atrial fibrillation ablation

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Abstract
A 49-year-old man with persistent atrial fibrillation (AF) underwent catheter ablation of AF [pulmonary vein (PV) isolation, left atrial linear lesions, and ablation of complex fractionated atrial electrograms], with a 3.5 mm open-irrigation ablation catheter. Overall, 4.4 L of crystalloid fluid was administered during the procedure. Seventy-two hours post-discharge, the patient reported symptoms of dyspnoea and a 3.6 kg weight gain. The electrocardiogram was unchanged and demonstrated sinus rhythm. A chest X-ray and computed tomography scan were ordered; the former demonstrated pulmonary oedema and the latter ruled out pulmonary embolism and PV stenosis. Trans-thoracic echocardiography (TTE) demonstrated new right ventricular (RV) dilation ( Figure 1 A and B ) and elevation of the RV systolic pressure (RVSP) to 49 mmHg without change in the right or left ventricular systolic function. The patient was admitted to a hospital with a diagnosis of congestive heart failure (CHF) and treated with intravenous loop diuretics. The following day, a repeat TTE demonstrated normalization of the RV size ( Figure  1 C and D ) and RVSP coincident with resolution of the patient's symptoms and weight gain.

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