Man Awakens With "Fluttering" in His Chest

ANSWER

This ECG is consistent with coarse atrial fibrillation with a rapid ventricular response and a nonspecific T-wave abnormality. The patient’s presentation is strongly suggestive of lone atrial fibrillation: This was the first incidence, it occurred in the absence of an existing heart condition, and it presented with an abrupt onset of increased heart rate and dyspnea.

Lone atrial fibrillation most commonly occurs in men in their 40s and 50s. It is vagally mediated, occurring during sleep or relaxation and after food and/or alcohol consumption.

The patient was cardioverted to normal sinus rhythm in the ED without difficulty, and follow-up was arranged.