Article, Emergency Medicine

The cause of paroxysmal atrial fibrillation: hyperbaric oxygen therapy or carbon monoxide poisoning?

Correspondence

Mira Kinariwala MD Department of Emergency Medicine Hospital of the University of Pennsylvania Philadelphia, PA 19104, USA

247

The cause of paroxysmal atrial fibrillation: Hyperbaric oxygen therapy or carbon monoxide poisoning?

To the Editor,

E-mail address: [email protected]

Kelly E. Quinley BA

Perelman School of Medicine University of Pennsylvania, Philadelphia, PA 19104, USA

Elizabeth M. Datner MD* Department of Emergency Medicine Hospital of the University of Pennsylvania Philadelphia, PA 19104, USA

Courtney A. Schreiber MD, MPH* Department of Obstetrics and Gynecology Hospital of the University of Pennsylvania Philadelphia, PA 19104, USA

http://dx.doi.org/10.1016/j.ajem.2012.07.014

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* co-principal investigators.

I enjoyed reading the article entitled “Paroxysmal atrial fibrillation after hyperbaric oxygen therapy” recently published online in American Journal of Emergency Medicine [1]. The authors presented a 78-year-old woman referring to them with loss of consciousness and the diagnosis of Carbon monoxide poisoning (carboxyhemoglobin of 42.6% in arterial blood gases analysis) who underwent Hyperbaric oxygen therapy. After HBO therapy, they noticed Atrial fibrillation in their patient, which responded to treatment with amiodarone. The authors have claimed that no study has reported AF after HBO therapy to date. However, a very important point about this case is that although the patient has developed AF after HBO therapy, CO poisoning itself can cause AF [2]. This may especially be more common in an aged patient (as the authors have themselves declared aging as a risk factor for development of AF) because the prevalence of AF rises markedly with age: approximately 0.1% at age 40 years, 6% at age 65 years, and 10% at age 80 and older [3,4]. It seems that the authors assumed AF to be due to HBO therapy because it reoccurred after the second session of HBO therapy on the second day of admission. However, as we know, cardiac dysrhythmias may occur as long as the patient is in the acute phase of CO poisoning. How could the authors exclude CO poisoning itself as a potential cause of AF in their patient? Thank you for this interesting case report.

Nasim Zamani Department of Clinical Toxicology Loghman-Hakim Poison Hospital

Shahid Beheshti University of Medical Scienses

Tehran, Iran E-mail address: [email protected]

http://dx.doi.org/10.1016/j.ajem.2012.07.015

References

  1. Celbek G, Boz BV, Caglar SO, Aydin LY, Kandis H, Saritas A. Paroxysmal atrial fibrillation after hyperbaric oxygen therapy. Am J Emerg Med 2012; http://dx.doi.org/10.1016/j.ajem.2012.03.021.
  2. Huang YC, Liu H, Ho K, Lien F. Carbon monoxide intoxication presented as paroxysmal atrial fibrillation. Acta Cardiol Sin 2006;22: 45-8.
  3. Kannel WB, Benjamin EJ. Current perceptions of the epidemiology of atrial fibrillation. Cardiol Clin 2009;27:13-24.
  4. Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA 1994;271:840-4.

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