Abstract

A 56-year-old man described a 9-year history of intermittent palpitations. This was confirmed to be recurrent paroxysmal atrial fibrillation. The episodes would typically last for hours and were well tolerated, with heart rates up to the 120s. He described the episodes as not being related to any specific activity, food, or mental state. A healthy lifestyle was noted that included regular exercise. The patient’s medical history, family history, review of systems, and physical examination were unremarkable except that his father had coronary heart disease and congestive heart failure and died at 89 years of age. Pertinent laboratory data includes a normal free T4, thyroid-stimulating hormone, and chemistry profile. M-mode and two-dimensional echocardiography revealed all valves, left ventricle, and ejection fraction to be normal. The left atrium was at the upper limits of normal, at 3.56 cm (normal, 1.9 to 4.0 cm). A stress echocardiogram was normal with the exception of an episode of rapid atrial fibrillation during the later part of the exercise period, which resolved several minutes into recovery phase.