Correction of Hypernatremia Due to Pure Dehydration Could Be a Potential Risk Factor for Transient Atrial Fibrillation

Although atrial fibrillation (AF) has been correlated with hyponatremia, it has not been described in association with the correction of chronic hypernatremia in previous studies. Here, we describe three elderly patients who had hypernatremia on presentation, most likely secondary to dehydration. Their electrocardiogram (EKG) on presentation was normal, and they had no known history of AF but developed transient AF during the course of hypernatremia correction. Similar occurrences have not been reported previously though there have been studies showing the relation between hyponatremia and AF. It is known that atrial stretch can increase the propensity of rapid firing from the pulmonary veins as a result of stretch-sensitive ion channels. Therefore, the occurrence of AF in these patients could be explained by the phenomenon of increase in right atrial diameter, i.e atrial stretch, in response to the increase in preload during the course of treatment. However, there are many other clinical scenarios where boluses of fluid are given during treatment but no occurrences of AF have been reported so far. So, we put forward the possibility of the occurrence of AF being independently associated with the drop in sodium level. Further studies like speckle tracking echo might shed more light on these findings.