• Sharon De Cruz, Anna Selvaggio, Ravi Aysola, Sanjay Bindra, Alex Padilla, and Michelle Zeidler.
• Division of Pulmonary, Critical Care, and Sleep Medicine, University of California at Los Angeles School of Medicine, Los Angeles, CA. Electronic address: sdecruz@mednet.ucla.edu.
• Chest. 2018 Oct 1; 154 (4): e97-e100.

Case PresentationA 67-year-old man with a history of atrial fibrillation (AF) presented to his physician with symptoms of episodic, nighttime palpitations and excessive daytime sleepiness. Four years prior he underwent radiofrequency ablation after a confirmed diagnosis of AF with subsequent resolution of his palpitations. His palpitations returned approximately 1 year following the ablation. These events would occur only at night and awake him from sleep. Holter monitoring showed baseline sinus rhythm with multiple episodes of AF with rates of 75 to 169 beats/min. These events were all nocturnal and correlated with the symptom diary; episodes ranged from 45 min to 2 h. An echocardiogram showed normal left ventricular size and ejection fraction with a mildly enlarged right atrium (4.38 cm) and no evidence of pulmonary hypertension.Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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