Postoperative Atrial Fibrillation in a Patient With Hypertrophic Obstructive Cardiomyopathy After Morrow Septal Myectomy May Evolve Into Lethal Ventricular Arrhythmia

Postoperative atrial fibrillation (AF) is a common complication for patients undergoing cardiac surgery. However, in patients undergoing a Morrow septal myectomy procedure, postoperative AF can be disastrous. A 42-year-old man underwent a Morrow septal myectomy procedure for hypertrophic obstructive cardiomyopathy that was resistant to medical treatment. Doppler echocardiography demonstrated that the peak left ventricular outflow tract gradient dropped from 96 to 7 mm Hg at rest after the procedure. The patient was doing well until the sudden onset of AF on the fifth night after surgery. Although medical conversion measures were promptly provided, the AF nonetheless evolved into ventricular fibrillation about 13 minutes after AF onset. The medical staff had to perform non-synchronized defibrillation to restore effective circulation. At 2 years after the procedure, the patient had not experienced AF recurrence and has recovered well. J Med Cases. 2016;7(1):26-27 doi: http://dx.doi.org/10.14740/jmc2152w