Use of wearable cardioverter‐defibrillator in association with catheter ablation for atrial fibrillation‐related tachycardiomyopathy

Implantable cardioverter‐defibrillator (ICD) implantation is not indicated in patients with potentially transient or reversible causes of sudden cardiac death (SCD). Wearable cardioverter‐defibrillator (WCD) is increasingly used for SCD prevention in patients who are temporary at high risk of ventricular arrhythmia. Hereby, we describe a case of tachycardiomyopathy successfully managed with ablation and WCD backup. Implantable cardioverter‐defibrillators are a Class I indication by American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines to prevent SCD in patients with nonischemic dilated cardiomyopathy, New York Heart Association (NYHA) functional class II and III, left ventricular ejection fraction (LVEF) ≤35% and with a life expectancy of >1 year.1 In addition, current guidelines recommend deferring implantation of ICDs for 40 days or three months postmyocardial infarction (MI), depending on whether acute revascularization is achieved.1 Recently, the benefits of ICD implantation in patients with DCM have been reconsidered after the results of the DANISH trial.2 A global assessment, beyond LVEF, may help to improve the appropriateness of ICD indication by identifying those patients who may benefit more from ICD implantation. Recently, wearable cardioverter‐defibrillators (WCDs) have emerged as a reasonable choice for patients in whom recovery of the LVEF is expected.3 A small subset of patients with atrial fibrillation (AF) experience dilated cardiomyopathy (DCM) also called tachycardiomyopathy. Typically, these patients have rapid ventricular rates and persistent AF. It has been shown that patients with tachycardiomyopathy related to AF benefit from ablation with a significant improvement in the LVEF as well as a reduction in the left ventricular end‐diastolic diameter (LVEDD) and left atrial diameter (LAD).4 The outcome of patients with tachycardiomyopathy after catheter ablation did not differ from that of patients without structural heart disease.4, 5 Hereby, we describe a patient with AF and recurrent relapses of heart failure (HF) who underwent successful AF ablation and postprocedural management with the WCD.