Case 2
A 52-year-old man with persistent AF was referred to our center for
further evaluation and management. He had exertional dyspnea of NYHA
functional class II and a history of hypertension, type 2 diabetes, and
transient ischemic attack. His medications included atorvastatin,
dabigatran, furosemide, linagliptin, metformin, and telmisartan. A
24-hour Holter tracing demonstrated persistent AF with a mean HR of 41
bpm (minimum 32 bpm, maximum 105 bpm), and repeated NSVT up to a maximum
of 20 beats (Figure 1B-a and 2B). TTE showed an LVEF of 60%, LA
diameter of 44 mm, and mild pulmonary hypertension. The patient was
scheduled for electrical cardioversion for rhythm control. After
electrical cardioversion, complete atrioventricular (AV) block was
observed (Figure 1B-b). A permanent pacemaker was implanted without any
complications, and the patient was discharged with no symptoms. Six
months later, he experienced sudden cardiac arrest due to polymorphic VT
(Figure 3B). After ROSC, the CAG showed minimal CAD. We replaced the
pacemaker with an ICD. Amiodarone was added, and the patient was
discharged with no complications. However, he experienced appropriate
ICD shocks several times for sustained VT and VF after discharge.