Fingers On The Wrist And Taming The Funny Current Rejuvenate The Wounded Heart: Ivabradine Responsive Atrial Tachycardia

A 19-year-old male presented with dyspnoea on exertion NYHA class II and occasional palpitations for 6 months. He was initially evaluated elsewhere and was being treated as a case of dilated cardiomyopathy. However, there was no improvement in his symptoms. On current evaluation at our centre, his previous electrocardiograms appeared normal. However, on palpating his radial pulse for a minute revealed runs of regular tachycardia, interspersed by normal pulse rate. A long 30 seconds rhythm strip ECG revealed multiple runs of ectopic tachycardia originating from the right atrial appendage, interspersed by ectopic atrial rhythm. Echocardiography revealed severe LV dysfunction with ejection fraction of 20-25%. He was advised radio-frequency ablation. However, since patient was not willing for ablation, he was started on ivabradine. After a month, his symptoms completely resolved. ECG revealed normal sinus rhythm without any runs of tachycardia and his left ventricular ejection function improved.