Electric cardioversion of atrial fibrillation resulting in pulmonary oedema in patient with apical hypertrophic cardiomyopathy.

The direct-current electric shock is considered to be safe treatment of arrhythmias and rarely leads to serious hemodynamic complications. A 62-year-old patient was admitted to the hospital due to a first symptomatic episode of atrial fibrillation. Patient was diagnosed with apical hypertrophic cardiomyopathy 20 years ago. Transoesophageal echocardiography was performed to exclude an atrial thrombus followed by electrical cardioversion with restoration of sinus rhythm. After 6 hours symptoms of pulmonary oedema developed. The patient's condition improved after furosemide administration. As the possible cause of the oedema, inotropic effect of administered propafenone and atrial stunning were considered. The atria seem to be responsible for important part of forward cardiac output even during AF, especially in cardiomyopathies. Contractility deterioration of the left atrium (stunning) along with earlier resumption of the right atrium contractile function could be associated with hemodynamic instability causing pulmonary oedema in subjects with hypertrophied myocardium. It is necessary to take into consideration the atrial function while administrating antiarrhythmic drugs, especially those with negative inotropic effect.