Paroxysmal Atrial Fibrillation in a Young Man which Lead to Stroke: A Case Report

Richard Antonius, Randy Adiwinata, Prasetyo Andriono

Abdi Waluyo Hospital Jakarta, Indonesia
richard.antonius29@gmail.com

INTRODUCTION:

Atrial Fibrilation (AF) is the most common sustained cardiac arrhythmia. Although AF becomes
increasingly more prevalent with aging, it also affects young people. AF that lead to stroke in young adult
may cause significant impairment to quality of life. Furthermore, paroxysmal AF tend to be harder to be
recognized.

CASE ILLUSTRATION:

A-28-year-old-male-patient presented with left side hemiparesis and dysarthria since 8 hours ago. Upon
examination, vitals signs were normal except for irregularly-irregular pulse rate of 151 bpm. Left sided
weakness and palsy of left-facial-nerve were found. ECG examination showed AF with rapid ventricular
response. Brain-CT-scan confirmed multiple lacunar infarct at lateral-periventricle and bilateral-thalamus.
MRI confirmed ischemic infarct at both cerebellum and sclerotic at both cerebral. The patient also
underwent Carotid Duplex Examination which showed normal carotid duplex with arrhythmia and
Transcranial Code Color Duplex and Bubble contrast Examination showed normal TCCD and negative
right to left shunt. Laboratorium test showed normal value (including Thyroid panel), except elevated D-
dimer. 24-hour-Holter-examination on this patient showed a result of paroxysmal atrial fibrillation as it
captured in total 154 ventricular events out of which there were 152 single and 2 bigeminies. There were
also captured in total 12860 supraventricular events out of which there were 1593 single, 613 bigeminies,
3267 trigeminies, 1351 quadrigeminies, 3186 couplets, 649 triplets and 105 runs. Echocardiography
showed….. The patient experienced significant clinical improvement after treated with metoprolol 50 mg,
amiodarone 200 mg, and dabigatran 110 mg twice daily for five days. On Follow-up visit, he felt much
better and less fatigue also his vital signs were normal with regular pulse rate of 62 bpm.

DISCUSSION:

Atrial fibrillation in young adult may lead to thromboembolic event. Compared to non-paroxysmal AF,
Paroxysmal AF was related with higher thromboembolic risk due to intermittent organized contraction of
the atria following period of AF. Young AF patient tend to more likely present with palpitation and
atypical chest pain. Holter may help the diagnosis of paroxysmal AF. Stroke prevention with
anticoagulant should be initiated whenever indicated, as it may significantly reduce the thromboembolic
risk.

Keywords: Paroxysmal Atrial Fibrilation, young adult, stroke, thromboembolic event