PS-R02-10: SYNCOPE ASSOCIATED WITH PAROXYSMAL ATRIAL FIBRILLATION AND ITS TREATMENT WITH CRYOABLATION

Abstract

Aims: The main objective to present this case is creating awareness about syncope attacks and cryoablation procedure. Case report: A 60-year-old female patient was admitted to the cardiology department of Suleyman Demirel University Research and Education Hospital from an external center with the complaint of syncope attacks. The patient stated that she fainted with loss of consciousness while working. Patient was diagnosed before with hypertension and is being under treatment with 5 mg of ramipril (1x1). Patient was examined with echocardiography and electrocardiogram, after evaluating results, pathology was not founded. Ejection fraction (EF) %60, mitral regurgitation and tricuspid regurgitation were minimum, pulmonary artery pressure was 28 mmHg. For further examination, rhythm Holter and tension Holter were preferred. As results of tension holter, tension was regular and there was no hypotension. As results of rhythm holter, multiple paroxysmal atrial fibrillation attacks with the longest 5.3 pause was observed. Average heart rate was 55 beats per minute, for this reason beta blockers werent chosen as a treatment. Patient was recommend to undergo cryoablation procedure. Cryoablation procedure was performed with Medtronic The Arctic Front Advance through femoral vein. Afterwards, a transeptal passage was made from the right atrium to the left atrium with a Brockenbrough needle. Four pulmonary veins in order of left lower, left upper, right lower, right upper were isolated from extra focuses electrophysiologically without complication. The patient was called for monthly checkups and prescribed with edoksaban tosilat. After checkups, syncope attacks and palpitations were not founded. In three month checkup, the patient was examined with rhythm Holter, pause and paroxysmal atrial fibrillation were not observed. Results: Syncope is a sudden consciousness with a loss of postural tone which caused by pathologies. Epidemiology and prognosis of syncope is various in general population. Syncope can be caused by neurological diseases or cardiovascular problems. Since syncope attacks occur as a symptom of many diseases, they ought to be investigated gradually. Patients with syncope associated with paroxysmal atrial fibrillation are predisposed to an abnormal neural response during both sinus rhythm and arrhythmia. In some patients the onset of atrial fibrillation triggers vasovagal syncope. However, in our case, there were pauses due to atrial fibrillation with a slow ventricular response, and syncope probably developed due to this phenomenon. Therefore, ablation was a curative treatment in our patient. As a conclusion further studies are needed to figure out the relationship between syncope and cardivascular diseases.