Management with rhythm monitoring, antiarrhythmics, and anticoagulation in an 18-year-old female with congenital heart defects resulted in clinical stability and no stroke recurrence over 2.5 years.
Case Report (n=1)
This case highlights the critical need for long-term follow-up and individualized management, including anticoagulation and rhythm control, in young patients with congenital heart disease and early-onset arrhythmias.
Rationale: Atrial septal defect (ASD) is a common congenital heart defect that can lead to left-to-right shunting, volume overload, and subsequent right atrial dilation – conditions that predispose to atrial arrhythmias such as atrial fibrillation (AF). The coexistence of Ebstein anomaly further increases the risk of early-onset arrhythmias and thromboembolic events. Stroke in young patients with such congenital abnormalities remains a rare but serious complication. Patient concerns: An 18-year-old female presented with intermittent palpitations and exertional chest discomfort. She had a past medical history of AF, Ebstein anomaly, repaired ASD, and a previous ischemic stroke. Despite early surgical interventions, including ASD closure and tricuspid valve plasty, she continued to experience arrhythmias. Diagnoses: Echocardiography showed mildly reduced left ventricular function with an ejection fraction of 45%, and electrocardiogram revealed rapid AF and right bundle branch block. Her history, clinical findings, and past echocardiograms confirmed recurrent AF associated with congenital structural heart defects, including ASD and Ebstein anomaly. Interventions: Management included rhythm monitoring, supportive care, and lifestyle modifications. A prior stroke prompted consideration of long-term anticoagulation and ongoing cardiac monitoring to reduce thromboembolic risk. Antiarrhythmic therapy and follow-up imaging were used to assess cardiac function and arrhythmic burden. Outcomes: The patient showed clinical stability on follow-up, with improved ejection fraction and no recurrence of stroke. Serial electrocardiograms and echocardiograms over 2 and a half years revealed no major complications, although arrhythmic risk remained elevated. Lessons: This case underscores the importance of long-term follow-up in patients with congenital heart disease, even after surgical correction. The coexistence of ASD and Ebstein anomaly can predispose to early-onset AF and stroke. Early detection and individualized management strategies, including rhythm control and anticoagulation, are critical in reducing morbidity and preventing recurrence.
Altell et al. (Fri,) conducted a case report in Recurrent atrial fibrillation and stroke with congenital heart defects (n=1). Rhythm monitoring, antiarrhythmic therapy, and anticoagulation was evaluated on Clinical stability, ejection fraction, recurrence of stroke, and major complications. Management with rhythm monitoring, antiarrhythmics, and anticoagulation in an 18-year-old female with congenital heart defects resulted in clinical stability and no stroke recurrence over 2.5 years.