A case report of atrial fibrillation in early adulthood: dig deeper

Abstract

Background Atrial fibrillation is a common cardiac arrhythmia which is often associated with underlying risk factors and undiagnosed conditions, including congenital heart disease. Atrial septal defects come to mind, albeit arrhythmias usually present later in life. We present herewith a young patient with cor triatriatum sinister, with some delay in establishing the diagnosis, following new onset atrial fibrillation in early adulthood. Case summary A 31-year-old man presented with pre-syncope and coryzal symptoms and was newly diagnosed with atrial fibrillation in the context of an intercurrent viral illness. After treatment with oral anticoagulation and successful outpatient cardioversion he was discharged from cardiology review. Two years later he re-presented with exercise intolerance and a 12-lead electrocardiogram revealing recurrence of atrial fibrillation. Subsequent investigation with transthoracic echocardiography revealed the underlying congenital cardiac defect of cor triatriatum sinister, together with an atrial septal defect and patent foramen ovale. After corrective surgery, which involved membrane resection, a cox-maze procedure and atrial septal defect closure, sinus rhythm was restored and at follow-up the patient had returned to baseline function. Discussion Young patients presenting with new onset atrial fibrillation should undergo thorough cardiovascular assessment to identify treatable causes and reversible risk factors. Cor triatriatum sinister is a rare congenital anomaly that may present in adulthood and give rise to symptomatic atrial fibrillation. Surgical correction including a cox-maze procedure in our patient resulted in restoration of sinus rhythm and a return of the patient’s baseline functional status and improved quality of life.

Hidden problems in a case of atrial fibrillation

“…8 Symptomatic CTS in adulthood is explained by fibrosis and calcification of the membranous defect, secondary to obstruction, mitral regurgitation, or AF. 9 In these patients, the clinical findings are CTS in an analogous manner to mitral stenosis. 10,11 The diagnosis of CTS is rare in adults, and the isolated form or classical type, with a single wide opening, is the most frequent in this age group.…”

“…In patients with CTS, the presentation, and severity of symptoms depends on the size of the communication between the two chambers by the presence of a fibromuscular membrane within the LA 8 . Symptomatic CTS in adulthood is explained by fibrosis and calcification of the membranous defect, secondary to obstruction, mitral regurgitation, or AF 9 . In these patients, the clinical findings are usually AF (32.8%), CHF‐related symptoms (26.9%), thromboembolic events (15.8%), and pulmonary hypertension (14.6%).…”