Abstract

Left atrial calcification (LAC) has been reported in 13.8 % of patients after atrial fibrillation (AF) ablation, which is related with stiff LA physiology and increased cardiovascular events. We describe a case in which long-term persistence of atrial inflammation caused by radiofrequency catheter ablation (RFCA) resulted in LAC. A 73-year-old man who underwent three previous AF ablations presented to our institution with a chief complaint of shortness of breath upon exertion. Electrocardiography showed a normal sinus rhythm, and transthoracic echocardiography revealed mild pulmonary hypertension. A marked decrease was observed in the mitral Doppler A-wave. Right heart catheterization showed marked V-wave augmentation in the pulmonary artery wedge pressure waveform despite the absence of mitral regurgitation, leading to a diagnosis of stiff LA syndrome. Computed tomography images revealed atrial wall thickening consistent with the ablation sites 6 months after the first ablation, which reflected inflammation-induced edema. LAC occurred at the site of atrial wall edema and expanded over several years. Mitral Doppler tracing showed a decrease in the A-wave two years and nine months after the first detection of LAC. This case demonstrates inflammation-induced atrial edema can persist for months after RFCA and may adversely affect atrial function years later.