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AN UNUSUAL CAUSE OF ATRIAL FIBRILLATION
2276 JACC March 21, 2017 Volume 69, Issue 11
FIT Clinical Decision Making AN UNUSUAL CAUSE OF ATRIAL FIBRILLATION Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: FIT Clinical Decision‐Making: Prevention, Adult Congenital and Congenital Heart Disease Abstract Category: Congenital Heart Disease Presentation Number: 1169-432 Authors: Shuangbo Liu, James Tam, Malek Kass, University of Manitoba, Winnipeg, Canada Background: Atrial fibrillation (AF) can be associated with many etiologies.
Case: 38 year old male with no past medical history presented with AF with rapid ventricular response. The patient’s heart rate was irregularly irregular at 140 bpm and blood pressure was 126/72 mmHg. Clinical exam and chest x-ray showed pulmonary edema. Transthoracic echocardiogram demonstrated a dilated left atrium (51 mm) with cor triatriatum sinister. Continuous wave Doppler showed continuous flow across the membrane with peak diastolic gradient 6 mmHg, peak systolic gradient 2 mmHg and mean gradient 4 mmHg across the cardiac cycle. The left ventricle was dilated and ejection fraction was 25%.
Decision‐Making: We discussed acute and long-term management of AF and anticoagulation in the setting of cor triatriatum. Since he was hemodynamically stable, he was started on rate controlling medication, Heparin infusion and Warfarin. Based on the gradients across the membrane, the severity of obstruction was deemed moderate. As he was diuresed, he spontaneously converted to sinus rhythm. The patient was discharged with follow up in our congenital heart disease clinic. The dilated cardiomyopathy was not in keeping with the underlying congenital condition, and could be tachycardia-induced. Conclusions: This case highlights an unexpected cause of AF. Cor triatriatum is a rare congenital condition predisposed to AF due to abnormal atrial anatomy. Analogous to mitral stenosis, AF is not well tolerated in cor triatriatum patients.
FIT Clinical Decision Making AN UNUSUAL CAUSE OF ATRIAL FIBRILLATION Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: FIT Clinical Decision‐Making: Prevention, Adult Congenital and Congenital Heart Disease Abstract Category: Congenital Heart Disease Presentation Number: 1169-432 Authors: Shuangbo Liu, James Tam, Malek Kass, University of Manitoba, Winnipeg, Canada Background: Atrial fibrillation (AF) can be associated with many etiologies.
Case: 38 year old male with no past medical history presented with AF with rapid ventricular response. The patient’s heart rate was irregularly irregular at 140 bpm and blood pressure was 126/72 mmHg. Clinical exam and chest x-ray showed pulmonary edema. Transthoracic echocardiogram demonstrated a dilated left atrium (51 mm) with cor triatriatum sinister. Continuous wave Doppler showed continuous flow across the membrane with peak diastolic gradient 6 mmHg, peak systolic gradient 2 mmHg and mean gradient 4 mmHg across the cardiac cycle. The left ventricle was dilated and ejection fraction was 25%.
Decision‐Making: We discussed acute and long-term management of AF and anticoagulation in the setting of cor triatriatum. Since he was hemodynamically stable, he was started on rate controlling medication, Heparin infusion and Warfarin. Based on the gradients across the membrane, the severity of obstruction was deemed moderate. As he was diuresed, he spontaneously converted to sinus rhythm. The patient was discharged with follow up in our congenital heart disease clinic. The dilated cardiomyopathy was not in keeping with the underlying congenital condition, and could be tachycardia-induced. Conclusions: This case highlights an unexpected cause of AF. Cor triatriatum is a rare congenital condition predisposed to AF due to abnormal atrial anatomy. Analogous to mitral stenosis, AF is not well tolerated in cor triatriatum patients.