Atrial fibrillation (AF) management is every day healthcare practice at the emergency department, in-patient setting, and out-patient setting. It is a priority to identify and treat reversible causes of AF before committing the patient to an unnecessary lifelong medical regimen that may include antiarrhythmics and anticoagulants. We report a case of middle age patient with recurrent episodes of AF triggered by a concealed accessory pathway, he was on Rivaroxaban and Sotalol for years, then later successfully treated with catheter ablation of the accessory pathway. A 48 years old white Caucasian male with history of recurrent episodes of AF, he was initially treated with Rivaroxaban, Sotalol, and underwent electrical cardioversions for four times. He eventually had a successful catheter ablation after comprehensive electrophysiological study had revealed a concealed Accessory Pathway (AP), he is currently off Rivaroxaban and Sotalol. This case highlights the importance of detection and treatment of the reversible causes of atrial fibrillation in young and middle aged patients. By applying this practice, physician will be able to avoid the unnecessary use of anticoagulation and anti-arrhythmic therapy in young and middle age group of patients.
Conflict(s) of Interest
References with DOI
1.Chugh SS, Blackshear JL, Shen WK, Hammill SC, Gersh BJ. Epidemiology and natural history of atrialfibrillation: clinical implications. J Am Coll Cardiol. Feb 2001;37(2):371-378. https://doi.org/10.1016/s0735-1097(00)01107-4
2. Lip GY, Brechin CM, Lane DA. The global burden of atrial fibrillation and stroke: a systematic review of the epidemiology of atrial fibrillation in regions outside North America and Europe. Chest. Dec 2012;142(6):1489-1498. https://doi.org/10.1378/chest.11-2888
3. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. Feb 25 2014;129(8):837-847. https://doi.org/10.1161/circulationaha.113.005119
4. Kannel WB, Abbott RD, Savage DD, McNamara PM. Epidemiologic features of chronic atrial fibrillation: the Framingham study. N Engl J Med. Apr 29 1982;306(17):1018-1022. https://doi.org/10.1212/01.wnl.0000407150.80523.a4
5. Nalliah CJ, Sanders P, Kottkamp H, Kalman JM. The role of obesity in atrial fibrillation. Eur Heart J. May 21 2016;37(20):1565-1572.
6. Sharma AD, Klein GJ, Guiraudon GM, Milstein S. Atrial fibrillation in patients with Wolff-Parkinson- White syndrome: incidence after surgical ablation of the accessory pathway. Circulation. Jul 1985;72(1):161-169. https://doi.org/10.1161/01.cir.72.1.161
7. Wellens HJ, Durrer D. The role of an accessory atrioventricular pathway in reciprocal tachycardia. Observations in patients with and without the Wolff-Parkinson-White syndrome. Circulation. Jul 1975;52(1):58-72. https://doi.org/10.1161/01.cir.52.1.58
8. Farshidi A, Josephson ME, Horowitz LN. Electrophysiologic characteristics of concealed bypass tracts: clinical and electrocardiographic correlates. Am J Cardiol. May 22 1978;41(6):1052-1060. https://doi.org/10.1016/0002-9149(78)90857-3
9. Campbell RW, Smith RA, Gallagher JJ, Pritchett EL, Wallace AG. Atrial fibrillation in the preexcitation syndrome. Am J Cardiol. Oct 1977;40(4):514-520. https://doi.org/10.1016/0002-9149(77)90065-0
10. Hamer ME, Wilkinson WE, Clair WK, Page RL, McCarthy EA, Pritchett EL. Incidence of symptomatic atrial fibrillation in patients with paroxysmal supraventricular tachycardia. J Am Coll Cardiol. Apr 1995;25(5):984-988. https://doi.org/10.1016/0735-1097(94)00512-o
Aljadi, Abdelrahman M. and Baryun, Esam
"Recognition and Treatment of Atrial Fibrillation Caused by Accessory Pathway in A middle Age Patient.,"
Marshall Journal of Medicine:
4, Article 8.
Available at: https://mds.marshall.edu/mjm/vol3/iss4/8