Remarkable oxygen consumption improvement after auricular flutter ablation in a patient with constrictive pericarditis and severe mitral stenosis.

Atrial function is a key factor in cardiac output and oxygen consumption (VO2). Substantial improvements in VO2 have been reported after restoring sinus rhythm (SR) in patients with atrial fibrillation. However, there are no published data on how atrial function affects VO2 in patients with both constrictive pericarditis (CP) and severe mitral stenosis (MS). A 53-year-old caucasian patient consulted for exacerbated heart failure (EHF). His medical record lists ischemic heart disease, severe MS, and CP after thoracic radiotherapy. The electrocardiogram showed atrial flutter (AFL) with controlled ventricular rate. Normal left ventricular ejection fraction was observed. Ergospirometry showed an impaired maximum VO2 (VO2 max) of 6 ml/kg/min. On the electrophysiological study typical AFL was diagnosed and ablated achieving a great exercise capacity improvement, correlated with an increase of VO2 max to 16 ml/kg/min a week after ablation, and disappearance of EHF symptoms. This case illustrates how restoration of SR resulted in a clinical substantial improvement. Radiofrequency catheter ablation is warranted as the most effective option in this context. <Learning objective: Atrial function impairment has a marked impact on cardiac dynamics in patients with both severe constrictive pericarditis and mitral stenosis. In this setting, sinus rhythm restoration should be pursued.>.