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Successful electrical cardioversion in a massive concentric hypertrophic cardiomyopathy with atrial fibrillation

Servet Altay1, Huseyin Altug Cakmak, Serhan Ozcan

  • 1Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey. svtaltay@gmail.com

The American Journal of Emergency Medicine
|April 26, 2011
PubMed

Insights

This study highlights successful electrical cardioversion for a patient with hypertrophic cardiomyopathy and atrial fibrillation. The procedure restored sinus rhythm, improving cardiac function and reducing outflow tract obstruction.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology

Background:

  • A 59-year-old male with hypertrophic cardiomyopathy (HCM) and chronic atrial fibrillation (AF) presented with symptoms of heart failure.
  • Initial evaluation revealed AF with rapid ventricular response, intraventricular conduction delay, and left ventricular (LV) hypertrophy.

Observation:

  • Transthoracic echocardiography demonstrated significant LV concentric hypertrophy with midventricular turbulent flow, despite no baseline LV outflow tract (LVOT) gradient.
  • Transesophageal echocardiography excluded left atrial thrombus.
  • Electrical cardioversion successfully converted AF to sinus rhythm.

Findings:

  • Post-cardioversion echocardiography revealed a significant LVOT gradient (54 mm Hg resting, increasing to 84 mm Hg with Valsalva).
  • Cardiac MRI confirmed marked concentric LV hypertrophy (35 mm diastolic thickness), mild anterior wall scarring, and right ventricular hypertrophy (10 mm diastolic thickness).
  • 24-hour Holter and exercise ECG testing showed no significant arrhythmias.

Implications:

  • Electrical cardioversion can be effective in managing AF in patients with HCM, potentially unmasking or increasing LVOT gradients.
  • Careful hemodynamic monitoring and advanced imaging are crucial for assessing gradient changes post-cardioversion in HCM patients.
  • This case underscores the complex interplay between AF, HCM, and dynamic LVOT obstruction.

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