Spontaneous conversion of atrial fibrillation caused by severe hyperkalemia: A case report

Abstract

Rationale: Hyperkalemia is a life-threatening electrolyte disturbance which could lead to arrhythmias and potentially death.

Patient concerns: An 82-year-old male patient who presented typical electrocardiographic indications of hyperkalemia, including the absence of P waves, prolongation of QRS complex, sinoventricular conduction, bradyarrhythmia and tall peaked T waves. He developed a rare self-defibrillation of atrial fibrillation to sinus rhythm due to hyperkalemia. Besides, he developed secondary thrombosis caused by abrupt termination of atrial fibrillation.

Diagnoses: This patient was diagnosed with hyperkalemia, hypertension, and AF.

Interventions: He was treated with an intravenous infusion of calcium gluconate, insulin and dextrose, an oral kayexalate, and emergency hemodialysis.

Outcomes: The patient was managed effectively and discharged with stable status.

Lessons: Hyperkalemia could induce malignant arrhythmia with high mortality. Thus we suggested more attention be paid to monitoring electrolyte disorders and maintaining anticoagulation treatments to avoid thromboembolism.

Figure 1

The patient's 12-lead ECG. (A) ECG showed escaped normal rhythm, loss of P waves, prolongation of QRS interval (164 miliseconds), markedly ventricular bradyarrhythmia, right bundle-branch block, and peaked T waves, with a potassium level of 8.1 mmol/L. (B) ECG revealed sinus rhythm, right bundle-branch block, low amplitude P waves, near normal heart rates, and prolongation of the QRS duration, with a potassium level of 4.6 mmol/L. (C) ECG indicated atrial fibrillation with an average 88 bpm, right bundle branch block, with a potassium level of 4.8 mmol/L. ECG = electrocardiograph.