Diagnosis: Atrial Fibrillation.
Treatment: Inpatient admission.
The insurer denied the inpatient admission.
The denial is upheld.

The patient is a male. At the time of admission to the hospital, he had a past medical history significant for hypertension (HTN), paroxysmal atrial fibrillation on propafenone, and bradycardia. The patient presented for evaluation due to an episode of lightheadedness. There was no syncope, chest pain or fall. The patient was found to be in atrial fibrillation with rapid heart rate. He had a history of bradycardia, so no beta-blockers were used. The patient subsequently converted to sinus bradycardia with a three second conversion pause. He remained hemodynamically stable with normal blood pressures. He was seen in consultation by Cardiology and his propafenone was changed to as needed dosing. He was observed on telemetry to monitor for any additional pauses. The patient was discharged home with a plan for outpatient follow-up for possible ablation.

No, the proposed treatment was not medically necessary.

The patient with a known history of atrial fibrillation and sinus bradycardia, presented with an episode of atrial fibrillation. The patient was hemodynamically stable. The electrocardiogram revealed atrial fibrillation, which subsequently spontaneously converted to sinus rhythm. The patient had a three second conversion pause, and did not require a permanent or temporary pacemaker. There was no evidence of acute myocardial infarction, acute coronary syndrome (ACS), decompensated congestive heart failure (CHF), malignant arrhythmia or hemodynamic instability. No cardiac catheterization or electrophysiological (EP) study was planned during this admission. Therefore, the clinical information provided in the record submitted for review does not support medical necessity for this admission and the care required could have been provided at a lower level of care.