Case Study- Heartbeat Harmony Restored - Correcting atrial flutter and heart function

Cardiology | by Dr. Rakesh Sarkar | Published on 16/09/2024

Background

A 38-year-old woman from Bhagalpur with a history of rheumatic heart disease came to us with repeated palpitations and breathing difficulties over the past 4-5 months. Two years prior, she had undergone mitral valve replacement (MVR) surgery and had been on medication to manage symptoms. Despite being on optimal medication, her symptoms persisted, prompting her to seek further medical evaluation.

Investigation & Analysis

Clinical examination revealed signs of congestive heart failure, including an increased and irregular pulse rate. The patient was prescribed further investigations. 

• ECG showed atypical atrial flutter with a fast ventricular rate (fast heart beat).
• Echocardiography showed that the heart’s ability to pump blood was weak (with a low ejection fraction of 35%), but the mitral valves (which were replaced in the past) were working properly.
• Chest X-ray revealed bilateral lung field congestion, indicating fluid accumulation in both lungs. 

These findings led to the diagnosis of tachycardiomyopathy caused by atrial flutter with a rapid ventricular response, a complication following her previous MVR surgery.

Treatment & Management

To address her condition, the patient was recommended an electrophysiological (EP) study with 3D mapping and radiofrequency ablation. This involves 3 things:

• Electrophysiological (EP) study: A diagnostic procedure used to examine the electrical activity of the heart. It helps doctors understand how electrical signals travel through the heart and identify abnormal heart rhythms (arrhythmias).
• 3D mapping: This creates a detailed, three-dimensional image of the heart’s electrical activity.
• Radiofrequency ablation: A procedure used to destroy (or ablate) small areas of heart tissue that cause abnormal electrical signals.

Under the careful supervision of Dr. Sarkar and his team, this two-hour-long comprehensive procedure was executed to help restore normal sinus rhythm. The ablation procedure successfully corrected the arrhythmia, and she was discharged the following day with minimal supportive medication. 

Post-Procedure Follow-Up

The patient’s follow-up echocardiographic evaluation a week later showed significant improvement, with her ejection fraction rising to 50%. Over the past year, the patient has had no episodes of palpitations or breathing difficulties. Regular follow-up appointments have shown that her ECG and echocardiographic parameters remain stable and within normal ranges. We are elated to have given our patient a chance to lead a healthier and happier life.