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Atrial fibrillation (AF) management is an everyday healthcare practice at the emergency department, inpatient setting, and outpatient setting. It is a priority to identify and treat reversible causes of AF before committing the patient to an unnecessary lifelong medical regimen that may include antiarrhythmics and anticoagulants. We report a case of a middle-aged patient with recurrent episodes of AF triggered by a concealed Accessory Pathway (AP). He was on Rivaroxaban and Sotalol for years, then later successfully treated with catheter ablation of the accessory pathway. A 48-year-old white Caucasian male with a history of recurrent episodes of AF was initially treated with Rivaroxaban and Sotalol, and underwent electrical cardioversions four times. He eventually had a successful catheter ablation after a comprehensive electrophysiological study had revealed a concealed AP. He is currently off Rivaroxaban and Sotalol. This case highlights the importance of detection and treatment of the reversible causes of atrial fibrillation in young and middle-aged patients. By applying this practice, physicians will be able to avoid the unnecessary use of anticoagulation and anti-arrhythmic therapy in young and middle-aged patient groups.

Recognition and Treatment of Atrial Fibrillation Caused by Accessory Pathway in A middle Age Patient