[Case summary]
A 56-year-old woman had presented with symptoms of paroxysmal palpitation and chest tightness for 6 almost years, was admitted to our hospital this time with 10-day recurrence.
An operation of percutaneous mitral balloon dilation and valvuloplasty was performed on her for severe mitral stenosis caused by rheumatic heart disease at 13 years ago, and she recovered well postoperatively.
Symptomatic paroxysmal AF started with an episode of several hours at 6 years ago, oral medical therapy of warfarin was started for the subsequently frequent seizures although seizures could be reverted spontaneously. However, the medicine was terminated by herself 6 months later without recommendation of doctor. Cerebral infarction occurred at the fourth day of medical termination with the consequence of right limb hemiplegia, fortunately, medication and rehabilitation therapy were given positively and followed by favorable recovery. The diagnosis of hypertrophic cardiomyopathy (non-obstructive type) was established, while the attempt of radiofrequency ablation of AF was conducted at 3 years ago and failed due to recurrence 6 months later.
2 months ahead of her hospital admission this time, while accompanying her family in the infusion room of our hospital, the patient herself suffered from a sudden syncope along with limbs twitching which was immediately identified by electrocardiogram (ECG) monitoring to be ventricular fibrillation, luckily the sinus rhythm restored by emergency electric defibrillation.
Her hospitalization this time was due to 10-day recurrence of persistent AF with clinical manifestations of palpitation, chest tightness and dizziness. Key physical examinations included a blood pressure of 108 / 68 mmHg, a conscious mind, no moist crackles or wheezes within lungs, absolutely irregular heart rhythm, no extra cardiac sounds or obvious cardiac murmurs, no edema in both lower limbs. ECG showed atrial fibrillation and tachycardia, with mean heart rate of 140 bpm. echocardiographic measurements included left atrium diameter of 46mm, left ventricular end-diastolic diameter of 42mm, ventricular septal thickness of 21 mm, posterior left ventricular wall thickness of 9 mm, left ventricular ejection fraction of 57%.