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Atrial fibrillation (AF) is a frequent reason for emergency departmentvisits. According to current guidelines either rate- or rhythm-control areacceptable therapeutic options in such situations. In this report, we present thecomplicated clinical course of a patient with AF and a rapid ventricular response.Because of paroxysmal AF, the patient was on chronic oral anticoagulation therapywith warfarin. Pharmacological treatment was ineffective to control ventricularrate, and immediate synchronized electrical cardioversion was performed. One hourlater, the patient complained of chest pain in combination with marked ST-segmentelevation in the anterior leads. Cardiac catheterization with optical coherencetomography disclosed plaque rupture in the left main coronary artery without othersignificant stenosis. Stent implantation was performed successfully. During thecourse of the hospital stay, the patient remained asymptomatic and the ST-segmentelevations resolved. However, despite treatment with amiodarone it was notpossible to keep the patient permanently in sinus rhythm. Therefore, abiventricular pacemaker was implanted and AV node ablation performed.

cjem. canadian journal of emergency medical care/cjem

ST-segment Elevation Following Cardioversion of Atrial Fibrillation in the Emergency Department: Unmasked Myocardial Infarction due to Left Main Coronary Artery Plaque Rupture or Unspecific Finding?