Cor Vasa 2017, 59(5):e450-e453

Pitfalls in rate and rhythm control: Severe concomitant orthostatic hypotension unmasks after conversion to sinus rhythm

Nikolay Yu. Mironov^a,*, Shurat B. Gorieva^b, Sergey P. Golitsyn^a

^a Department of Clinical Electrophysiology, Russian Cardiology Research and Production Complex, Moscow, Russia

^b New Diagnostic Methods Department, Russian Cardiology Research and Production Complex, Moscow, Russia

Rate control is an attractive strategy in management of patients with recurrent atrial fibrillation. Typically, it is more simple approach than rhythm control. Once optimal ventricular rate control is achieved patients with long-lasting atrial fibrillation commonly remain in good clinical status and do not require subsequent readmissions and change of prescribed drugs and their doses. We report a case of effective rate control strategy failure after relatively long period due to transformation of atrial fibrillation into atypical atrial flutter. Subsequent spontaneous conversion to sinus rhythm improved patient's hemodynamic but unmasked concomitant orthostatic hypotension that was severe and had significant impact on treatment of patient.
Learning objective: Transformation to atrial flutter may cause failure of rate control strategy even in previously stable patients with long time persistent atrial fibrillation. Spontaneous conversion to sinus rhythm can unmask orthostatic hypotension. Management of comorbid orthostatic hypotension might be challenging as it could be severe and have significant impact on patients' condition.

Keywords: Atrial fibrillation and flutter; Orthostatic hypotension; Rate control; Spontaneous conversion

Received: April 4, 2016; Revised: August 1, 2016; Accepted: August 2, 2016; Published: October 1, 2017  Show citation