A case of cardiac amyloidosis presenting stiff left atrial syndrome with severe calcification after first AF ablation

Abstract

Scarring of the left atrial (LA) wall from atrial ablation (AF) leads to the development of stiff LA syndrome. Multiple ablation treatments have been considered to be associated with the development of LA calcification (LAC). We report a case of wild-type transthyretin cardiac amyloidosis (CA) who presented with worsening heart failure due to stiff LA syndrome despite the condition after initial ablation for AF. The case had LAC along the ablation point, a reduced LA reservoir strain by echocardiography, and a characteristic pulmonary artery wedge pressure waveform with markedly elevated v wave by right cardiac catheter examination consistent with stiff LA syndrome. Notably, in patients with CA, there may be a causal relationship between ablation for AF and LAC and development of stiff LA syndrome. When we encounter patients with worsening heart failure with CA after AF ablation, we should pay additional attention to stiff LA syndrome.

Learning objectives

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  In the case of worsening heart failure in patients who have undergone left atrial (LA) catheter ablation, the possibility of stiff LA syndrome due to calcification of the LA should be considered.
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  A detailed assessment of hemodynamics by echocardiography and right heart catheterization is useful for diagnosis of stiff LA syndrome.
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  In patients with cardiac amyloidosis treated with radiofrequency catheter ablation for atrial fibrillation, additional attention should be given to calcification of the LA and stiff LA syndrome.