Refractory atrial fibrillation with rapid ventricular rate in a patient with small cell carcinoma of the lung encasing the right pulmonary artery : A case report and insight into therapeutic options.

Abstract

Atrial fibrillation is the most common sustained cardiac arrhythmia. While there have been reports of atrial fibrillation caused by the compression of pulmonary veins, we have not found reports of atrial fibrillation caused by the compression of the pulmonary artery. This report highlights the possible pathophysiology and management of atrial fibrillation in a patient with small cell lung cancer.The patient was admitted for hyponatremia secondary to syndrome of inappropriate antidiuretic hormone (SIADH) but subsequently developed tachycardia which progressed to atrial flutter and atrial fibrillation. Antiarrhythmics were ineffective until the patient received his first palliative chemotherapy for his small cell lung cancer. Subsequently, rate control was achieved with sotalol, with eventual conversion back to sinus rhythm. Management of atrial fibrillation is complex and sometimes depends on the underlying etiology. Early chemotherapy, in addition to antiarrhythmic drugs, may be beneficial in the management of patients with small cell lung cancer and atrial fibrillation. The CHA2DS2-VASc score does not take active malignancy into account and anti-coagulation should be evaluated on a case-by-case basis in this patient population.

An Uncommon Case of Atrial Fibrillation due to a Lung Mass Invasion of the Left Atrial Cavity

“…In this case, the patient was given IV diltiazem and metoprolol pushes to control his AF; however, he reverted to RVRs between 130 and 150 beats/min. After the patient received his first round of chemotherapy, his heart rate decreased and converted to normal sinus rhythm with maintenance sotalol therapy [ 10 ]. While there are few cases like ours, one case report of a 58-year-old male who presented to the ER with dysphagia worsening with solids and a 10-kg unintentional weight loss over the span of 2 months matched closely with the presentation of our patient.…”

Chemotherapy-Induced Atrial Fibrillation With Rapid Ventricular Response in a Patient With Pleomorphic Rhabdomyosarcoma: A Case Report and Approach to Management

“…Atrial fibrillation (AF) is one of the most common cardiac arrhythmias in the general population along with atrial flutter [ 1 ]. It is estimated that three to six million people have been diagnosed with AF in the United States alone [ 2 ]. The most common risk factors for AF are hypertension, diabetes, advancing age, rheumatic and non-rheumatic valve disease, congestive heart failure, myocardial infarction, and certain drugs.…”