PAROXYSMAL ATRIAL-FIBRILLATION AS A CAUSE OF POTENTIALLY LETHAL VENTRICULAR ARRHYTHMIA WITH MYOCARDIAL-ISCHEMIA IN HYPERTROPHIC CARDIOMYOPATHY - A CASE-REPORT

The mechanism(s) of myocardial ischemia in hypertrophic cardiomyopathy remain unclear. In this report, the authors present a 75-year-old Jap anese woman with nonobstructive hypertrophic cardiomyopathy in whom pa roxysmal atrial fibrillation caused severe myocardial ischemia and ind uced sustained ventricular tachycardia. Her coronary angiogram showed normal findings, and no ischemic changes were provoked by either physi cal exercise testing or dobutamine stress echocardiography under sinus rhythm. In view of these findings, the rapid ventricular response in the absence of atrial contraction may aggravate or induce myocardial i schemia and predispose patients with hypertrophic cardiomyopathy to de velop lethal ventricular arrhythmia.