Case 151

A 37-year-old man is referred for evaluation of atrial fibrillation. He presented with his first episode of atrial fibrillation 6 months earlier. A nuclear perfusion stress test was reportedly normal. He was treated with atenolol and warfarin, and underwent electrical cardioversion. He had a second episode of atrial fibrillation 2 months ago and was started on oral amiodarone after another electrical cardioversion. A recent Holter monitor showed sinus rhythm without atrial fibrillation and a 5-beat run of nonsustained monomorphic VT. He was doing well without complaints and his physical examination was unremarkable. He denied syncope. He had not history of hypertension or other medical problems. However, he did recall that when he was a child, his mother was found dead at home unexpectedly at age 41.