213: ONE SHOCK TREATED WITH ANOTHER: NEW-ONSET ATRIAL FIBRILLATION AFTER HIGH-VOLTAGE ELECTRICAL INJURY

Abstract

Introduction: Development of atrial fibrillation following electrical injury has been rarely reported in literature. This can place medical providers in a situation where they are uncertain on how to manage such event. We present a case of high voltage electrical injury (7200V) resulting in new onset atrial fibrillation. Description: A 38-year-old electric line worker with no previous medical history came in with complaint of new onset palpitations and lightheadedness that started an hour prior to arrival. Patient stated he was standing on a boom lift, pressure-washing a church’s tower when his lance touched an electrical wire overhead. The lines were coming from a main electric pole estimated to be 7200V that connected to the transformer. Patient felt a shock pass through his right hand down to the rest of his body for a few seconds, and then he fell. He was not wearing any gloves. He denied any loss of consciousness, alcohol use, chest pain or any previous heart condition. In the ED, he was found to be in atrial fibrillation with heart rate ranging from 110-150. His CPK was 295 units/L and troponin was < 6 ng/L. Patient received IV diltiazem 15mg and IV amiodarone 150mg. He was started on amiodarone drip, admitted to ICU for monitoring and transitioned to Metoprolol 25mg BID and Xarelto 15mg daily the next day before discharge. Three weeks later, he underwent transesophageal echocardiogram (TEE) guided electrical cardioversion for persistent atrial fibrillation. Discussion: Electrical injury can induce cardiac arrhythmias via different mechanisms. The sheer energy of the electric current could directly stimulate the myocytes. It could also impair the sodium-potassium adenosine triphosphatase transporter which plays a major role in electrical-mechanical activity of cardiac muscle. Myocardial necrosis can also lead to production of new arrhythmogenic foci. Troponin and CPK are not always strong indicators of myocardial injury, however, high CK levels >400 units/L may be associated with longer hospitalization, and a greater risk of skin grafting or amputation. Atrial fibrillation in setting of electrical injury is managed with the use of beta blockers, anti-arrhythmics and in some cases, electrical cardioversion.