| Abstract [eng] |
Arterial hypertension is the most common etiological risk factor for atrial fibrillation due to its high prevalence in the population and its role in causing cardiac changes that promote atrial fibrillation: structural changes in the atrial myocardium, atrial dilation, and the development of an atrial fibrillation substrate. The majority of arterial hypertension (about 95%) is essential hypertension, but hypertension can also be caused by clear secondary causes, such as pheochromocytoma. Therefore, timely and appropriate identification and treatment of the cause can have a significant impact on the course and treatment of atrial fibrillation. This paper describes a clinical case of a patient with poorly controlled arterial hypertension for many years who developed paroxysms of atrial fibrillation. After cardioversion using amiodarone infusion and correction of arterial hypertension with a combination of 7 antihypertensive drugs, the patient experienced recurrent paroxysms despite rate control with a betablocker. After considering long term control, it was decided to perform a pulmonary vein isolation procedure, after which the episodes of atrial fibrillation ceased. However, patient‘s hypertension became poorly controlled again with 3-4 episodes of hypertensive crises per week. Having a treatment-resistant hypertension, secondary cause was suspected. The patient underwent a thorough examination, which revealed an adrenal incidentaloma. Serum free metanephrines testing confirmed an active pheochromocytoma. Laparoscopic adrenalectomy was performed promptly, and after the removal of the pheochromocytoma, hypertension was controlled with a combination of 5 antihypertensive drugs. This was necessary for maintaining long-term effect of pulmonary vein isolation, therefore the patient did not experience recurrent paroxysms of atrial fibrillation. Consequently, timely and proper management of the comorbidity achieved a sufficient solution for rhythm control. This case highlights that the management of atrial fibrillation is complex and should not be limited to rhythm control alone. It is crucial to timely investigate and address underlying causes that contribute to the development of atrial fibrillation and may affect the long-term success of pulmonary vein isolation. Only by correcting these underlying causes we can expect long-term success in rhythm control. |
