History and Presentation:
A 50-year-old man comes to the emergency department due to intermittent palpitations over the last 6 months. The patient describes them as "very uncomfortable" and says the episodes occur randomly, last for several hours, and resolve spontaneously or with sleep. The current episode started an hour ago and has been accompanied by lightheadedness.
Past Medical and Surgical History: Unremarkable
Physical Examination:
On physical examination, he is found to have
Paroxysmal Atrial Fibrillation
Discussion:
This patient's presentation with intermittent palpitations and cardiac rhythm strip showing an irregularly irregular rhythm with varying R-R intervals and no discernible P waves is consistent with paroxysmal atrial fibrillation (AF).
Pathophysiology:
The development of AF involves structural and electrical changes that predispose to the initiation and maintenance of electrical reentrant circuits and/or ectopic foci. These pathologic changes, termed atrial remodeling, can occur as a result of normal aging or diseases that cause atrial dilation (eg, hypertension, mitral regurgitation). The remodeling leads to shortening of the atrial refractory period and heterogeneity in localized electrical conduction between atrial myocytes, creating a substrate for the development of AF.
The most common trigger is aberrant electrical foci in the pulmonary veins near their ostia into the left atrium; therefore, catheter ablation of pulmonary vein trigger sites (pulmonary vein isolation) is used for the treatment of symptomatic, paroxysmal AF.
Treatment:
Pt did not have any episode of lightheadedness or any chest discomfort and Holter’ monitor ECG showed no arrhythmia in the last 2 weeks
A 50-year-old man comes to the emergency department due to intermittent palpitations over the last 6 months. The patient describes them as "very uncomfortable" and says the episodes occur randomly, last for several hours, and resolve spontaneously or with sleep. The current episode started an hour ago and has been accompanied by lightheadedness.
Past Medical and Surgical History: Unremarkable
Physical Examination:
On physical examination, he is found to have
- BP: 112/68mmHg
- Pulse 45bpms
- Temp: 98F
- Respiration 20/min
- CNS: GCS 15/15 with normal motor and sensory responses
- Respiration: NVB+0
- GIT: abdomen is soft and non-tender and bowel sounds are audible (3/min)
- CVS: Rapid heart rate, taping apical pulse, S1 and S2 audible and no apparent murmurs.
- No peripheral edema
- BMI: 30 kg/m2
- ECG:
- Echocardiography (ECHO): shows normal ventricular function with no major valvular disease.
Paroxysmal Atrial Fibrillation
Discussion:
This patient's presentation with intermittent palpitations and cardiac rhythm strip showing an irregularly irregular rhythm with varying R-R intervals and no discernible P waves is consistent with paroxysmal atrial fibrillation (AF).
Pathophysiology:
The development of AF involves structural and electrical changes that predispose to the initiation and maintenance of electrical reentrant circuits and/or ectopic foci. These pathologic changes, termed atrial remodeling, can occur as a result of normal aging or diseases that cause atrial dilation (eg, hypertension, mitral regurgitation). The remodeling leads to shortening of the atrial refractory period and heterogeneity in localized electrical conduction between atrial myocytes, creating a substrate for the development of AF.
The most common trigger is aberrant electrical foci in the pulmonary veins near their ostia into the left atrium; therefore, catheter ablation of pulmonary vein trigger sites (pulmonary vein isolation) is used for the treatment of symptomatic, paroxysmal AF.
Treatment:
- Initially the patient is given beta blocker, sotalol to control HR and later digoxin was added until cardiac ablation was not done.
- Following day, the patient underwent for cardiac ablation of pulmonary veins near the ostia. It resolved the arrhythmia.
Pt did not have any episode of lightheadedness or any chest discomfort and Holter’ monitor ECG showed no arrhythmia in the last 2 weeks