A sudden onset of parossistic atrial fibrillation

A 67 years old woman with a medical history notable for arterial hypertension presented with sudden onset of parossistic atrial fibrillation and shortness of breath. On examination, she appeared in good health condition. The blood pressure was 155/85 mm Hg, the pulse 125 beats per minute and the axillary temperature 36.5°C; the respirations were 24 breaths per minute. There was a grade 3/6 holosystolic murmur above the cardiac apex radiating posteriorly. Electrocardiography confirmed the presence of parossistic atrial fibrillation (Figure 1); a transthoracic echocardiography revealed a mass (3.4 by 7.8 cm) (Figure 2) attached to the left atrial septum and protruding through the mitral valve into the left ventricle, suggestive of a myxoma. Given the risk of systemic embolization and sudden syncope, the patient underwent prompt surgical resection of the mass (Figure 3). Pathological evaluation revealed a benign myxoma (Figure 4). The patient had a postoperative good course and was discharged home on the seventh postoperative day.