We submit an unusual presentation of spontaneous atrial fibrillation in a young, fit, active-duty U.S. military African-American male without evidence of structural heart disease. His atrial fibrillation was refractory to several ablation treatments over the course of 3 years. Subsequently he was diagnosed with extracardiac sarcoidosis and a fluorodeoxyglucose-positron emission tomography (FDG-PET) scan identified bi-atrial hypermetabolic lesions, concerning for cardiac sarcoidosis. Given the low incidence of atrial fibrillation in patients < 45 years-of-age, this case report aims to underscore consideration of cardiac sarcoidosis as a subclinical contributor towards developing atrial fibrillation in the appropriate patient population. Broadly more investigations are needed to explore the role of cardiac sarcoidosis with atrial involvement and the likelihood of developing atrial arrhythmias.
1) Atrial fibrillation (AF) in the absence of overt cardiac disease may be the first indication of another underlying disease. Therefore, AF in patients < 45y, which is refractory to catheter ablation should prompt further work-up for an underlying cause.
2) Cardiac sarcoid (CS) is known to cause congestive heart failure and a fatal complication, ventricular arrhythmias (VAs). Supraventricular arrhythmias (SVAs) in CS are infrequently described in literature, are less common than VAs, and include atrial tachycardia, atrial ectopy, atrial flutter, and AF.
Credits: Ali Hussain, Alvin C. Yiu, Uzoagu A. Okonkwo, John-paul O’shea