Rare Coronary Embolism Secondary to Cardioversion of Atrial Fibrillation

Abstract

The diagnosis and management of myocardial infarction with nonobstructive coronary arteries (MINOCA) are difficult due to its variable presentations, different causes, and challenging diagnostic approaches. Cardiac imaging modalities including cardiac magnetic resonance (CMR) are very useful tools for diagnosing and managing MINOCA. Myocardial infarction (MI) can be caused by coronary emboli that can be contributed to atrial fibrillation (AF). Rarely, coronary embolism with resultant MINOCA can occur after direct current cardioversion (DCCV) even in fully anticoagulated patients. We present a rare case of a coronary embolism following DCCV as well as a CMR finding of microvascular obstruction (MVO), which has not previously been reported after DCCV. This case also emphasizes the value of obtaining a CMR for patients with MINOCA.

A Case of Low Ejection Fraction Unrelated to Anthracycline Therapy: Chemo Tells a Fib

“…7 In patients with multiple risk factors for HF, CMR has the potential to differentiate anthracycline-induced cardiomyopathy from other non-ischemic causes of HF, such as AF, and may play an essential role in guiding HF management and improving patient outcomes. 8,9 Recent studies have explored the prognostic value of CMR in predicting LVEF improvement following AF ablation in patients with non-ischemic heart failure with reduced ejection fraction (HFrEF). 5,10 The absence of LV fibrosis, as detected by LGE and T1 extracellular volume fraction mapping, has been shown to correlate with greater improvement in LV systolic function following AF ablation.…”

“… 7 In patients with multiple risk factors for HF, CMR has the potential to differentiate anthracycline-induced cardiomyopathy from other non-ischemic causes of HF, such as AF, and may play an essential role in guiding HF management and improving patient outcomes. 8 , 9 …”