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Spontaneous conversion of atrial fibrillation to normal sinus rhythm following recurrent cerebral infarctions.

Oh K, Choi JY, Kim BJ - J Korean Neurosurg Soc (2013)

Bottom Line: During admission, second ischemic attack occurred in right middle cerebral artery territory.Restored sinus rhythm sustained until he died due to sepsis.This case is evidence supporting a theory that brain is associated with control of cardiac rhythm.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
Post-stroke atrial fibrillation has been frequently reported especially in the patients with right insular infarct as an evidence of cerebrogenic mechanism affecting on cardiac rhythm. However, conversion to normal sinus rhythm after stroke in patients who had atrial fibrillation has not been reported. A 88-year-old men who had untreated atrial fibrillation was admitted to hospital due to left middle cerebral artery territory infarction. During admission, second ischemic attack occurred in right middle cerebral artery territory. At that time, his atrial fibrillation converted spontaneously to normal sinus rhythm. Restored sinus rhythm sustained until he died due to sepsis. This case is evidence supporting a theory that brain is associated with control of cardiac rhythm. If no risk factor is revealed by intensive investigation in patients with acute cerebral infarctions that cardioembolism is strongly suspected as a cause, physicians should concern transformation of atrial fibrillation to normal sinus rhythm after stroke.

No MeSH data available.


Related in: MedlinePlus

Electrocardiogram (12 leads) which was performed on admission reveals atrial fibrillation with rapid ventricular rhythm.
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Figure 2: Electrocardiogram (12 leads) which was performed on admission reveals atrial fibrillation with rapid ventricular rhythm.

Mentions: On admission, he was mild drowsy and not communicated. Neurological examinations showed right hemiparesis of grade IV (Medical Research Council grade) and aphasia. Gaze deviation or visual field defect was not detected. Diffusion-weighted MRI showed multiple small cortical infarcts in left middle cerebral artery territory without involvement of insular cortex (Fig. 1A). Electrocardiogram (12 leads) revealed atrial fibrillation with rapid ventricular rhythm (Fig. 2). Echocardiogram revealed moderate aortic valve regurgitation and left atrial enlargement with diameter of 44.7 mm (Aorta, 28.1 mm) on M-mode study. However, ejection fraction was normal and thrombus was not observed in the atrium or ventricle. We started treatment with heparin and digoxin for atrial fibrillation with rapid ventricular rhythm, but did not use antiarrhythmic agent. After few days, digoxin was stopped due to decrement of heart rate less than 40/min. Seven days after admission, anticoagulation was stopped because of gross hematuria. Eighteen days after admission, intubation was performed due to purulent sputum and severe stridor induced by epiglottitis. His right-sided weakness progressed to hemiplegia of grade III, but other neurologic symptoms did not deteriorate.


Spontaneous conversion of atrial fibrillation to normal sinus rhythm following recurrent cerebral infarctions.

Oh K, Choi JY, Kim BJ - J Korean Neurosurg Soc (2013)

Electrocardiogram (12 leads) which was performed on admission reveals atrial fibrillation with rapid ventricular rhythm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756131&req=5

Figure 2: Electrocardiogram (12 leads) which was performed on admission reveals atrial fibrillation with rapid ventricular rhythm.
Mentions: On admission, he was mild drowsy and not communicated. Neurological examinations showed right hemiparesis of grade IV (Medical Research Council grade) and aphasia. Gaze deviation or visual field defect was not detected. Diffusion-weighted MRI showed multiple small cortical infarcts in left middle cerebral artery territory without involvement of insular cortex (Fig. 1A). Electrocardiogram (12 leads) revealed atrial fibrillation with rapid ventricular rhythm (Fig. 2). Echocardiogram revealed moderate aortic valve regurgitation and left atrial enlargement with diameter of 44.7 mm (Aorta, 28.1 mm) on M-mode study. However, ejection fraction was normal and thrombus was not observed in the atrium or ventricle. We started treatment with heparin and digoxin for atrial fibrillation with rapid ventricular rhythm, but did not use antiarrhythmic agent. After few days, digoxin was stopped due to decrement of heart rate less than 40/min. Seven days after admission, anticoagulation was stopped because of gross hematuria. Eighteen days after admission, intubation was performed due to purulent sputum and severe stridor induced by epiglottitis. His right-sided weakness progressed to hemiplegia of grade III, but other neurologic symptoms did not deteriorate.

Bottom Line: During admission, second ischemic attack occurred in right middle cerebral artery territory.Restored sinus rhythm sustained until he died due to sepsis.This case is evidence supporting a theory that brain is associated with control of cardiac rhythm.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
Post-stroke atrial fibrillation has been frequently reported especially in the patients with right insular infarct as an evidence of cerebrogenic mechanism affecting on cardiac rhythm. However, conversion to normal sinus rhythm after stroke in patients who had atrial fibrillation has not been reported. A 88-year-old men who had untreated atrial fibrillation was admitted to hospital due to left middle cerebral artery territory infarction. During admission, second ischemic attack occurred in right middle cerebral artery territory. At that time, his atrial fibrillation converted spontaneously to normal sinus rhythm. Restored sinus rhythm sustained until he died due to sepsis. This case is evidence supporting a theory that brain is associated with control of cardiac rhythm. If no risk factor is revealed by intensive investigation in patients with acute cerebral infarctions that cardioembolism is strongly suspected as a cause, physicians should concern transformation of atrial fibrillation to normal sinus rhythm after stroke.

No MeSH data available.


Related in: MedlinePlus