[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%.