Deceptive nature of atrial premature contractions: ablating 2 arrhythmias with 1 burn.

Abstract

An 82-year-old man with a history of diabetes mellitus, hypertension, chronic kidney disease, polycythemia, hypothyroidism, T-cell lymphoma, and prostate cancer presented with complaints of dyspnea on exertion for several months. He underwent extensive evaluation including an echocardiogram, which showed normal left ventricular systolic function with an ejection fraction of 63%, left ventricular hypertrophy, moderate aortic stenosis, and mild to moderate aortic regurgitation. A cardiac catheterization showed normal filling pressures with moderate aortic stenosis. He was thought to have tachy-brady syndrome because of episodes of rapid atrial fibrillation and sinus bradycardia at rest. Because of exercise associated fatigue and dyspnea, the patient was referred for pacemaker implantation. Careful inspection of hospital telemetry revealed frequent atrial premature contractions (APCs), often in a bigeminal pattern, which blocked in the AV node and caused compensatory reset of the sinus node, …