A 60-year-old male with obesity (body-mass index 43 kg/m(2)) presented with recurrent symptomatic atrial fibrillation (AF), which he had had since age 41 years. The AF was refractory to treatment with antiarrhythmic drugs. Pacemaker implantation for tachycardia-bradycardia syndrome was required as well as ablation for atrial flutter, and the patient underwent a total of four DC cardioversions. Sleep studies showed mild to moderate obstructive sleep apnea, but continuous positive airway pressure was not tolerated. Pacemaker interrogations demonstrated mode-switch episodes, indicating continuing AF. He was scheduled for catheter ablation targeting pulmonary vein antral isolation. He embarked on a weight-loss program, which successfully reduced AF burden.Echocardiography, stress testing, polysomnography, pacemaker interrogations and C-reactive protein.AF, atrial flutter, tachycardia-bradycardia syndrome, obstructive sleep apnea and morbid obesity.Antiarrhythmic drug therapy, DC cardioversion, anticoagulation, atrial flutter ablation, permanent pacemaker implantation, continuous positive airway pressure and weight loss.
View details for DOI 10.1038/ncpcardio0027
View details for Web of Science ID 000202931500015
View details for PubMedID 16265261