TACHYCARDIA-MEDIATED HEART FAILURE SECONDARY TO RIGHT ATRIAL APPENDAGE ATRIAL TACHYCARDIA IN A COLLEGIATE FOOTBALL PLAYER

Background

The right atrial appendage (RAA) is an uncommon site of origin for focal atrial tachycardias (AT). RAA AT can mimic sinus tachycardia and lead to a tachycardia-mediated cardiomyopathy.

An 18 year old football player with a history of asthma presented with abdominal pain and tachycardia. His tachycardia persisted despite fluid boluses and a trial of adenosine. ECG revealed a regular, narrow-complex short RP tachycardia with upright p-waves in leads I and II (Figure). Of note, a pre-participation physical ECG obtained eight months earlier demonstrated normal sinus rhythm with a first degree AV block. An echocardiogram at that time showed a low normal ejection fraction of 45-50%.

Decision Making

Echocardiography showed severe global systolic dysfunction with an ejection fraction of 15-20%. Given the drastic reduction in systolic function in a previously healthy athlete and new short RP tachycardia, we had a high clinical suspicion for an AT. An electrophysiology study exposed an ectopic AT originating in the RAA. Four months after a successful ablation and optimal medical therapy, echocardiography showed full recovery of his systolic function.

Conclusions

This case demonstrates the importance of maintaining a high index of suspicion for AT in patients with new systolic heart failure in the setting of narrow complex arrhythmias refractory to usual therapy for sinus tachycardia.


Autor / Fonte:Shivanshu Madan; James Hummel; Mario Ciocca; et al. J Am Coll Cardiol. 2016;67(13_S):1240-1240. doi:10.1016/S0735-1097(16)31241-4.
Link: http://content.onlinejacc.org/data/Journals/JAC/935148/12414.pdf