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https://doi.org/10.15836/ccar2022.232

Atrial fibrillation as first presentation of constrictive pericarditis

Petar Martinčić orcid id orcid.org/0000-0001-8141-1749 ; Dr. Tomislav Bardek General Hospital, Koprivnica, Croatia
Sandra Jakšić-Jurinjak orcid id orcid.org/0000-0002-7349-6137 ; University Hospital Centre Zagreb, Zagreb, Croatia
Vlatka Rešković-Lukšić orcid id orcid.org/0000-0002-4721-3236 ; University Hospital Centre Zagreb, Zagreb, Croatia
Marija Brestovac orcid id orcid.org/0000-0003-1542-2890 ; University Hospital Centre Zagreb, Zagreb, Croatia
Blanka Glavaš Konja orcid id orcid.org/0000-0003-1134-4856 ; University Hospital Centre Zagreb, Zagreb, Croatia
Zvonimir Ostojić orcid id orcid.org/0000-0003-1762-9270 ; University Hospital Centre Zagreb, Zagreb, Croatia
Joško Bulum orcid id orcid.org/0000-0002-1482-6503 ; University Hospital Centre Zagreb, Zagreb, Croatia
Martina Lovrić-Benčić orcid id orcid.org/0000-0001-8446-6120 ; University Hospital Centre Zagreb, Zagreb, Croatia
Jadranka Šeparović-Hanževački orcid id orcid.org/0000-0002-3437-6407 ; University Hospital Centre Zagreb, Zagreb, Croatia


Puni tekst: engleski pdf 340 Kb

str. 232-233

preuzimanja: 174

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Sažetak

Ključne riječi

cardiac imaging; constrictive pericarditis; atrial fibrillation

Hrčak ID:

287548

URI

https://hrcak.srce.hr/287548

Datum izdavanja:

8.12.2022.

Posjeta: 590 *



Introduction: Atrial fibrillation (AF) and other cardiac arrhythmias can be provoked by diverse pathologies including pericarditis (1). Pericarditis can be caused by various causes and clinical presentation varies depending on the underlying etiology and time of presentation (1-3). Pharmacological treatment usually leads to symptom resolution, but still the possibility of constrictive hemodynamic remains.

Case series: 52-year-old male presented with right heart failure and AF. Three years earlier he had stroke due to left internal carotid artery dissection and AF was diagnosed as well as calcification of pericardium of unknown etiology. As the patient had no signs of heart failure, the heart team opted for pharmacological treatment at that time. On a follow up, regression of calcification did not occur even after treatment with non-steroidal anti-inflammatory drugs, colchicine, steroids and rhythm control of AF failed. Additionally, echocardiography revealed constrictive hemodynamic with septal bounce with a respiratory dependent septal shift to the right as a result of interventricular interdependence and severe calcification of the pericardium in front of both ventricles. Right heart catheterization confirmed the diagnosis. Computed tomography (CT) exposed massive calcification of the pericardium that led to pericardiectomy as the only treatment available (Figure 1). The second case is 45-year-old male who was admitted with symptoms of right heart failure and AF. After prior AF ablation treatment, sinus rhythm was maintained shortly. Echocardiography once again revealed signs of constrictive hemodynamic. CT unveiled severe calcification of pericardium in front of the right ventricle with pericardial effusion. Surgical pericardiectomy was indicated for right heart failure relief (Figure 2).

FIGURE 1 A. Pericardial calcification and shadowing due to calcium. B. Electrocardiogram showing atrial fibrillation and microvoltage. C. Cardiac computed tomography showing massive calcification.
CC202217_9-10_232-3-f1
FIGURE 2 A. Hepatic flow reversal with inferior vena cava plethora. B. Diastolic septal bounce best seen on M mode as septal notch in early diastole. C. Computed tomography showing pericardial calcification dominantly in front of the right ventricle.
CC202217_9-10_232-3-f2

Conclusion: Advanced constrictive pericarditis at the time of diagnosis was the reason pharmacotherapy and ablation treatment failed for AF. Possibly, constrictive hemodynamic was the initial trigger for AF that further accelerated heart failure. Multidisciplinary approach to pericardial disease and multimodality imaging is still the cornerstone of treatment, but echocardiography remains superior imaging modality in monitoring hemodynamic, best complemented with cardiac CT and right heart catheterization.

LITERATURE

1 

Chiabrando JG, Bonaventura A, Vecchié A, Wohlford GF, Mauro AG, Jordan JH, et al. Management of Acute and Recurrent Pericarditis: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 January 7;75(1):76–92. https://doi.org/10.1016/j.jacc.2019.11.021 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/31918837

2 

Schwartz C, Khadilkar AC, Bitetzakis C, Patel A. A Case of Atrial Flutter Masking Acute Pericarditis. Cureus. 2021 March 29;13(3):e14168. https://doi.org/10.7759/cureus.14168 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/33936880

3 

Imazio M, Bobbio M, Cecchi E, Demarie D, Demichelis B, Pomari F, et al. Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial. Circulation. 2005 September 27;112(13):2012–6. https://doi.org/10.1161/CIRCULATIONAHA.105.542738 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/16186437


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