Abstract
Introduction: Heart failure with reduced ejection fraction (HFrEF) and rapid atrial fibrillation often coexist, forming a vicious cycle that worsens hemodynamics. When pharmacologic therapy fails, the “pace and ablate” strategy offers effective ventricular rate control.
Case report: A 68-year-old male was admitted with decompensated HFrEF (EF 20%) and drug-refractory rapid atrial fibrillation. After initial optimization including early use of Tolvaptan, the patient underwent successful single-chamber ICD implantation and AV node ablation. Post-intervention, symptoms significantly improved with NT-proBNP reduced and EF improved at discharge.
Conclusion: The “pace and ablate” approach is effective in managing rapid AF in HFrEF, especially when combined with optimized medical therapy. Device selection should balance guideline-based recommendations and the patient's socioeconomic context.