ABSTRACT
A 62-year-old male presented to his treating cardiologist for routine interrogation of his implantable cardiac defibrillator on the background of severe ischemic cardiomyopathy and end-stage kidney disease on hemodialysis. The device log revealed multiple paroxysms of atrial fibrillation; however, upon scrutinizing these episodes it was evident that they always corresponded to episodes of hemodialysis while dialyzing through a chronic dialysis catheter, but not while dialyzing via an arteriovenous fistula. We report the novel finding of inappropriate sensing of current leak from the catheter by a lead with a floating atrial dipole.
Subject(s)
Atrial Fibrillation/etiology , Defibrillators, Implantable/adverse effects , Electromagnetic Phenomena , Kidney Failure, Chronic/therapy , Renal Dialysis/adverse effects , Electrocardiography , Humans , Male , Middle AgedSubject(s)
Abnormalities, Multiple/diagnostic imaging , Echocardiography , Heart Defects, Congenital/diagnostic imaging , Heart Septal Defects, Atrial/diagnostic imaging , Lower Extremity Deformities, Congenital/diagnostic imaging , Mitral Valve/abnormalities , Mitral Valve/diagnostic imaging , Upper Extremity Deformities, Congenital/diagnostic imaging , Adult , Female , HumansABSTRACT
BACKGROUND: Atrial fibrillation (AF) is increasingly common among Australia's ageing population and carries significant morbidity and mortality. Its detection through screening, cardiac device interrogation and/or symptoms of AF brings with it a number of significant clinical issues. OBJECTIVE: The aim of this article is to outline a systematic approach to the management of patients with AF, including the initial investigations required, rhythm versus rate control, anticoagulation for stroke prevention, and the interplay between AF and heart failure. DISCUSSION: Most patients with AF can be managed safely and effectively in the primary care setting. Rhythm control is pursued early in certain patients with AF who are at risk of decompensated heart failure. Specialist cardiology input is important in the treatment of AF coinciding with clinical heart failure, and for patients with medically refractory symptoms or slow/rapid heart rates.