Refractory unstable atrial fibrillation in a young Ethiopian patient with rheumatic heart disease: insights and challenges

Abstract

We report a case of a 28-year-old female with chronic rheumatic valvular heart disease and poor medication adherence presenting with unstable refractory atrial fibrillation. Initial bedside point-of-care ultrasound examination demonstrated significant bi-atrial dilatation, mitral valve thickening, moderate mitral regurgitation, and severe tricuspid regurgitation. Despite multiple attempts at electrical cardioversion, the patient was not successfully cardioverted. Intravenous amiodarone was subsequently administered as a form of chemical cardioversion leading to stabilization and successful conversion to sinus rhythm. This single case suggests that significant structural and valvular heart disease in atrial fibrillation may be negative predictive factors for unsuccessful electrical cardioversion. In these cases, consideration should be given to chemical cardioversion with medications such as amiodarone as a potential first-line strategy.