The problem of elderly patient management with arterial hypertension, long duration of multivessel coronary artery disease, recurrent myocardial infarctions was considered. As a consequence of these diseases, the patient developed ischemic cardiomyopathy with severe left ventricular dysfunction, which resulted in complex form of arrhythmia and heart failure. The main syndrome that determines the condition severity and patient’s prognosis is heart failure. Dynamics of changes in the ejection fraction is provided, which indicates the prerogative of the restoration and maintenance of sinus rhythm despite the presence of relative contraindications to cardioversion, such as an increase in the size of the left atrium up to 5.4 x 7.6 cm, a low ejection fraction up to 29 %, a marked ischemic myocardial remodeling. Conducted therapy that corresponds to the current recommendations, allowed to decrease the manifestations of heart failure, to increase the ejection fraction, to achieve restoration and retention of the sinus rhythm, and hemodynamic stabilization.
