Polycystic Liver With Cardiac Compression Leading to Atrial Fibrillation: Case Report and Review of the Literature

Abstract

Polycystic liver disease (PCLD) is a rare condition that most often occurs in patients with polycystic kidney disease and less commonly as an isolated liver disease. Complications include cyst rupture, infection, hemorrhage, and compression of surrounding organs by large cysts. We present the case of a patient with a history of PCLD who presented to our hospital with palpitations and was found to have atrial fibrillation. Imaging and echocardiograph revealed a dominant large cyst compressing the right atrium. Other etiologies including thyroid disease, ischemic heart disease, and electrolytes abnormalities were excluded. The patient refused surgical intervention and was conservatively treated with rate control and anticoagulation. To the best of our knowledge, this is the first case of new-onset atrial fibrillation secondary to right atrial compression by a liver cyst. Compression of cardiac chambers resulting in newonset arrhythmia should be considered when evaluating patients with PCLD.

Polycystin-1 loss of function increases susceptibility to atrial fibrillation through impaired DNA damage response

“…While it is wellestablished that hypertension exacerbates ADPKD, 91 the impact of other cardiac alterations, such as AF, should also be considered. These observations raise the possibility that PKD1 mutations may have systemic effects, contributing to multi-organ dysfunction and potentially leading to conditions like AF 21,23,[27][28][29] , even in the absence of kidney disease and vice-versa. Therefore, the role of PKD1 mutations and their potential influence on AF progression warrant further investigation.…”

“…[22][23][24][25][26] Indeed, a recent study from the US-National Inpatient Sample database, including 71,531 patients, revealed that a higher risk of AF and atrial flutter was observed among ADPKD in the younger age group (18-39 years of age) compared to those with CKD and without ADPKD (odds ratio of 5.71). 27 Given that ADPKD increases the risk of AF 21,23,[27][28][29] , we investigated whether mutations in PC1 contribute to increased AF inducibility. PC1 is not only implicated in ADPKD but is also ubiquitously expressed across multiple tissues, including the heart, showing its broader biological significance.…”