J Surg Case Rep. 2026 Jul 11;2026(7):rjag433. doi: 10.1093/jscr/rjag433. eCollection 2026 Jul.
ABSTRACT
Pectus excavatum (PE) is the most common congenital chest wall deformity but its association with atrial fibrillation (AF) remains underrecognized. We present a case where surgical correction of PE resulted in complete resolution of AF, highlighting the role of structural compression in lone AF and other arrhythmias. A 25-year-old male with PE presented with recurrent symptomatic AF without prior cardiovascular disease. Despite initial treatment with metoprolol and apixaban, episodes persisted. Chest CT demonstrated severe deformity (Haller index 5.6) and right atrial compression. Echocardiography showed a reduced ejection fraction (40%-45%). He underwent a Nuss procedure with dual bars and intercostal nerve cryoablation, resulting in immediate intraoperative relief of compression. There was no recurrence of AF at 9 months follow up. Severe PE may contribute to lone AF through mechanical compression. Surgical correction can provide symptom resolution in appropriate patients.
PMID:42436883 | PMC:PMC13354534 | DOI:10.1093/jscr/rjag433