Electrical Cardioversion for Atrial Flutter in a Patient with Severe Left Ventricular Systolic Dysfunction: A Case Report

Abstract

Background: Patients with chronic heart failure (CHF) and severe left ventricular systolic dysfunction (LVEF <35%) are at elevated risk for life-threatening arrhythmias. Atrial flutter (AFL) can precipitate acute hemodynamic instability in this population, often requiring urgent intervention.

Case Description: A 61-year-old male with ischemic cardiomyopathy (LVEF 31-34%), an implantable cardioverter-defibrillator (ICD), and paroxysmal atrial fibrillation presented with CHF decompensation. He developed typical AFL with 2:1 atrioventricular (AV) conduction, prompting intensive care unit (ICU) transfer due to impending hemodynamic deterioration. Despite optimized guideline-directed medical therapy, synchronized electrical cardioversion with a 100 J biphasic shock successfully restored sinus rhythm without complications.

Conclusion: This case illustrates the safety and efficacy of low-energy electrical cardioversion for acute rhythm control in AFL among patients with advanced heart failure and severe systolic dysfunction. It underscores the value of vigilant monitoring, the limitations of ICD therapy for supraventricular arrhythmias, and the need for multidisciplinary, individualized management to avert decompensation in high-risk patients.