Electrocution-induced atrial fibrillation: a novel cause of a familiar arrhythmia

Abstract

BACKGROUNDThis case presents a novel aetiology of a common arrhythmia. Although rare, there is no current consensus on the optimal management of electrical shock-induced atrial fi brillation. CASE PRESENTATIONA previously well 40-year-old man presented to the emergency department after suffering an 11 000 volt DC electrical shock from overhead power lines through a portable crane which he was manipulating from the ground. He had initially been unable to remove his right hand, the entry point, from the controller as it had experienced tetanic contraction. After approximately 5 s he was thrown backwards onto turf. He denied loss of consciousness, head injury, shortness of breath or chest pain, but admitted to lethargy, a dull generalised headache and occasional palpitations. Paramedics had initially noted an irregular tachycardia.On examination, he was of athletic build and comfortable at rest. His right hand was generally mildly tender but was normal to inspection. His left great toe, the exit point, had a small blister on the lateral aspect which was painful to touch. There was no evidence of internal burns or compartment syndrome in the limbs or thorax. There were no signs of haemodynamic compromise. His pulse was irregularly irregular at a rate of 80 beats per min. His blood pressure was stable at 120/80 mm Hg. INVESTIGATIONSFull blood count, urea and electrolytes, prothrombin time and activated partial thromboplastin time, creatine kinase, troponin T and thyroid function tests were all within normal ranges. Chest radiography was normal. A targeted echocardiographic study demonstrated normal left ventricular systolic function. Electrocardiography undertaken before a routine minor surgical procedure 3 years previously had demonstrated sinus rhythm ( fi gure 1 ). His ECG on this occasion showed atrial fi brillation with a controlled ventricular rate ( fi gure 2 ). TREATMENTThe patient was transferred to the coronary care unit for cardiac monitoring. He was given a therapeutic dose of enoxaparin and simple analgesia. A 150 mg bolus of fl ecainide over 10 min, given 4 h after the initial injury, failed to restore sinus rhythm. An amiodarone infusion (300 mg over 1 h followed by a further 900 mg over 23 h), started 11 h after the initial injury, restored sinus rhythm 24 h after the initial injury. DC cardioversion had been intended had the amiodarone infusion failed to work. OUTCOME AND FOLLOW-UPThe patient's palpitations ceased on restoration of sinus rhythm. He was discharged home the same day. Follow-up in 1 month with a transthoracic echocardiograph was arranged. DISCUSSIONAtrial fi brillation is by far the most common persistent cardiac arrhythmia, with approximately 1-2 per cent of adults being affected at any one time. Incidence increases with age, with 9 per cent of those aged 80 or over being affected. 1 Other main risk factors for the development of atrial fi brilllation include hypertension and valve disease; less common causes include thyroid dysfunction, alcohol abuse and malignancy. 2 Electrocution as...

Atrial fibrillation associated with high voltage electric shock in a young healthy female: a case report

“…Thereafter infusion amiodarone was given that showed successful reversal of atrial fibrillation into sinus rhythm. 7 Our case also represented a similar result though we used amiodarone infusion as an initial therapy. The current NICE guideline (June 2014) also suggests rhythm control with flecainide or amiodarone to be preferred in new onset atrial fibrillation.…”

Assessment of electrocardiographic parameters in patients with electrocution injury

“…Langford A. reported a case of atrial fibrillation induced by electrocution. [21] There are also cases of AV block secondary to EI in the literature. [22] In our study, PR intervals on admission ECGs were longer compared to follow-up ECGs but only 1 patient had PR interval longer than 200 ms.…”

A case of paroxysmal atrial fibrillation following low voltage electrocution

“…Atrial fibrillation however is not a common occurrence [2]. AF is known to occur with an increased incidence in advancing age, [3] and diabetes is a recognized risk factor for atrial fibrillation.…”

“…Electrical injury can cause a wide spectrum of cardiac complications ranging from myocardial necrosis with ventricular fibrillation [ 1 ] to less common arrhythmias. Atrial fibrillation however is not a common occurrence [ 2 ]. AF is known to occur with an increased incidence in advancing age, [ 3 ] and diabetes is a recognized risk factor for atrial fibrillation.…”

“…However, commonly it is seen in association with ischaemic or structural heart disease [ 4 ]. Only a handful of electrocution induced new onset AF incidents have been reported [ 2 , 5 - 9 ], including AF precipitated by a lightning strike [ 10 , 11 ] and a case of a marine diver being electrocuted by a torpedo(electric) ray [ 12 ]. The mechanism leading to injury can be explained by the pathway taken by the transient circuit created when electrocution takes place, as it determines the tissue at risk.…”