A Rare Complication: Post-Cardioversion Pulmonary Edema

Introduction

Electrical cardioversion is a widely used technique to resolve tachydysrhythmias such as atrial fibrillation. This procedure is easy to perform with a high success rate. Nevertheless, it is crucial to closely monitor patients subjected to cardioversion to identify any potentially life-threatening complications.

Case Presentation

We present here the case of a 63-year-old male with a history of hypertension, dilated cardiomyopathy, and ischemic heart disease. He came to the emergency department due to a sudden onset of rapid heartbeat and difficulty breathing. Upon physical examination, the patient appeared to have dyspnea, tachycardia (155 beats/min), low blood pressure (60/30mmHg), swelling in his lower limbs, and a swollen abdomen due to an accumulation of fluid in the abdominal cavity, without any signs of pulmonary edema. An electrocardiogram showed atrial fibrillation. Since the patient could not tolerate the arrhythmia, cardioversion was performed, and the patient successfully converted to normal sinus rhythm. However, shortly after the procedure, the patient's dyspnea worsened, with bilateral crackling sound on the base of his lung at auscultation. These signs indicated the presence of pulmonary edema. The patient improved shortly after receiving dialysis and diuretic therapy.

Conclusion

Electrical cardioversion plays a crucial role in the management of atrial fibrillation, demonstrating a high effectiveness in treating patients with recent onset of atrial fibrillation. While complications of cardioversion are rare, it is vital to thoroughly evaluate the patient's condition afterward and maintain a vigilant clinical monitoring post-procedure to ensure appropriate and effective rhythm control therapy (fig. 1 and 2).