Reversible Cardiomyopathy Due to Atrial Fibrillation in a 46‐Year‐Old Patient

Abstract

The authors describe the challenging case of a 46-year-old patient who presented with a 2-week history of exertional dyspnea, paroxysmal nocturnal dyspnea, and orthopnea. He was found to have left ventricular failure and atrial fibrillation with a rapid ventricular rate. Initial work-up revealed dilated cardiomyopathy with marked left ventricular dysfunction, without any obvious cause. He received standard medical therapy for left ventricular dysfunction and his symptoms improved. Electrical cardioversion to sinus rhythm and maintenance resulted in complete recovery of left ventricular function within 6 months. (c)2001 CHF, Inc.

Overview of the Management of Atrial Fibrillation:

“…In those rare cases where conventional AV nodal‐blocking agents are ineffective, such as in very ill patients, amiodarone may be useful because the drug's earliest effect, when administered intravenously, is negative dromotropism via its noncompetitive beta‐adrenergic and calcium channel‐blocking effects 6 . Careful rate control is paramount no matter which agent is used, because high heart rates over time may cause severe symptoms as well as profound left ventricular dysfunction in some individuals 8,9 . This is part of the rationale for considering AV nodal ablation and permanent pacemaker implantation in select patients who also may be suffering from severe symptoms caused by the rapidity and irregularity of their arrhythmia 8 .…”

“…6 Careful rate control is paramount no matter which agent is used, because high heart rates over time may cause severe symptoms as well as profound left ventricular dysfunction in some individuals. 8,9 This is part of the rationale for considering AV nodal ablation and permanent pacemaker implantation in select patients who also may be suffering from severe symptoms caused by the rapidity and irregularity of their arrhythmia. 8 The relative benefits of rate control versus rhythm control will be considered in a subsequent section of this article.…”