Serial electrical cardioversion for refractory atrial fibrillation with rapid ventricular response post ablation
Katherine Liu1,2, Nofel Iftikhar3, Latha Ganti4
1Future Physicians America, Orlando, FL, USA.
International Journal of Emergency Medicine
|October 1, 2025
Summary
This case study explores refractory atrial fibrillation (AF) with rapid ventricular response post-ablation. Serial electrical cardioversion (ECV) offers temporary relief but highlights the need for advanced strategies in persistent AF management.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Atrial fibrillation (AF) management often involves catheter ablation (CA).
- Recurrent or refractory AF post-CA presents significant clinical challenges.
- Rapid ventricular response in AF necessitates prompt and effective treatment.
Purpose of the Study:
- To present a unique case of refractory atrial fibrillation with rapid ventricular response following catheter ablation.
- To highlight the limitations of current AF management strategies in achieving durable rhythm control.
- To emphasize the importance of individualized treatment planning for complex AF cases.
Main Methods:
- Case report of a male patient in his 50s presenting with recurrent palpitations and tachycardia.
- Management involved serial electrical cardioversion (ECV) in the emergency department (ED).
- Discussion of potential advanced interventions for refractory cases.
Main Results:
- The patient experienced persistent tachycardia refractory to initial treatments.
- Serial ECV provided temporary rhythm control.
- The case underscores challenges in achieving durable rhythm control after CA.
Conclusions:
- Refractory AF post-ablation requires consideration of repeat ablation or atrioventricular nodal ablation with pacemaker placement.
- Serial ECV may serve as a bridge to more definitive therapies.
- Individualized treatment and timely follow-up are crucial for managing complex AF cases.
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