Chelsea Amo Tweneboah, MD, Alexander Kaiteris, DO, and Ryan F. Heslin, MD MBA

Introduction: Atrial Fibrillation is highly prevalent amongst a population that is older, has persistent atrial fibrilation, has structural heart disease,and other diseases including but not limited to the following: Heart, COPD, and obesity. Cathter ablation is achieved through the termination of triggers induced through the pulmonary veins. Patients who respond favorably to such a procedure are usually below the age of 70, symptomatic, no other arrhythmia present, normal cardiac function, normal BMI, and normal thyroid function to name a few. Different outcomes are said to determine the success of an ablation procedure include rhythm outcome post-procedure after single or multiple ablations, rhythm outcome with and without antiarrhythmics, rhythm outcome through monitoring, and the outcome of underlying clinical issues such as left ventricular function that may affect rhythm control. The clinical benefits of ablation, include symptomatic relief and, significant increase in exercise tolerance, increase in left ventricular ejection fraction, and reduced mortality. We present a case of a young male who presented with pre-excited atrial fibrillation and the effectiveness of catheter ablation given his presentation.

Case Description: An 18-year-old male presented to our institution with complaints of palpitations. The patient was found to have pre-excited atrial fibrillation with rapid conduction on electrocardiogram (ECG). He was found to have a left-sided accessory pathway with bidirectional conduction during an electrophysiological study (EPS). Patient was initially bolused with amiodarone which converted him back to sinus rhythm. The electrophysiology team was contacted for further management and patient underwent SVT Ablation on two sepearte occasions. Ablation resulted in the loss of pre-excitation in the bypass tract. During the procedure, patient subsequently developed atrial fibrillation in which he underwent a cardioversion in which he was converted back sinus rhythm Due to the patient’s post-operative left-sided abdominal and chest pain, he underwent a computed tomography (CT) scan, which revealed a pulmonary infarction. A hypercoagulable workup including Antithrombin III activity, Anticardiolipin, IgG/IgM antibodies, Factor V Leiden, Beta 2 glycoprotien IgM/IgG antibodies, and Protein C and S were all within normal limits. His family history was negative family for bleeding or clotting disorders. He was prescribed a short course of apixaban for the pulmonary infarction. His pleuritic pain and exercise capacity improved, without the development of respiratory symptoms. The patient has remained in sinus rhythm without further occurrence of Afib.

Discussion: Our case highlights the successful termination of a pre-excitation atrial fibrillation in a young healathy male. The effectiveness of an ablation technique requires the precise identification of the trigger of a given arrhythmia. Pulmonary vein isolation through ablation has been the main means of effectively reducing recurrence, improving patients' quality of life, and allowing individuals to achieve symptom control. Catheter ablation is currently a class `I indication for patients who have symptomatic supraventricular tachycardia This ablation procedure has about a 95% success rate being able to terminate arrhythmias with minimal complications effectively. One benefit of ablation is the reduction of mortality and thromboembolism. In comparison to antiarrhythmic drug therapy, there are benefits in the reduction of stroke incidences and increased survival especially noted in older populations. Although several risk factors makes one susceptible to atrial fibrillation including left atrial enlargement, structural heart disease, and left ventricular systolic or diastolic dysfunction, clinicians must prioritize an individual’s risk of developing atrial fibrillation as this task remains difficult and uncertain.