SAT-703 The Intersection of Obesity, Testosterone Therapy, and Atrial Fibrillation: A Case Report

Abstract Disclosure: M.J. Sheahan: None. L. Ranga: None. A. Ashkezari: None. Background: This case report details atrial fibrillation (Afib) in a 22-year-old male with a complex medical history, including morbid obesity, exogenous testosterone therapy, opioid use, and erythrocytosis. This case highlights the potential interplay between obesity, testosterone-induced erythrocytosis, and opioid use in the development of Afib. Clinical case: A 22-year-old male with a history of well-controlled diabetes mellitus (managed with Ozempic) and chronic back pain (treated with Belbuca and hydrocodone-acetaminophen) presented with palpitations and chest pain. His medical history was notable for morbid obesity, with a BMI of 66 in 2003, reduced to 47 by 2024 following significant weight loss. He was also receiving 200mg injections of testosterone cypionate for symptomatic low testosterone, alongside his other medications. In the emergency department, he was found to be in atrial fibrillation with Afib RVR at a heart rate of bpm, refractory to oral diltiazem but controlled with a continuous diltiazem infusion, reducing his heart rate to the 80s. Labs significant for elevated WBC at 14 x10^3/uL, suggesting possible infection or stress response. Labs also significant for elevated RBC at 6.69 x10^6/uL, Hemoglobin at 19 g/dL, and Hematocrit at 58.3%, with increased red cell distribution width (RDW) at 14.6%. Blood glucose levels were initially elevated at 177 mg/dL and trended down to 86 mg/dL. CTA negative for PE. Patient received TTE showing normal EF and no structural heart abnormalities. He was admitted for further management, including consideration for direct current cardioversion (DCCV), though he later converted to normal sinus rhythm with medical therapy alone. On initial evaluation, the patient was tachycardic, with a heart rate of up to 180 bpm in Afib RVR, resistant to oral diltiazem. A continuous intravenous diltiazem infusion successfully controlled his heart rate to the 80 bpm range. Patient started on 75mg metoprolol for rate control and eliquis for stroke prevention. He was subsequently started on a beta-blocker and returned to normal sinus rhythm without the need for TEE or DCCV. Conclusions: This case highlights the need for careful management of young patients with a complex medical history involving exogenous testosterone therapy, opioid use, and obesity. Clinicians should be vigilant in monitoring cardiovascular health and considering the risks of erythrocytosis in patients on testosterone therapy. Further research is needed to better understand the mechanisms linking hormonal therapy, erythrocytosis, and arrhythmias. Understanding these interactions can aid in the prevention and management of arrhythmias in similar patient populations. Presentation: Saturday, July 12, 2025