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Atrial Fibrillation as A Complication of Congestive Heart Failure in Elderly Patient: A Case Report Hizkia1, Michael Jonathan1, Levina Tri Ratana1, Arif Ridha1, Arinta Setyasari2, Prihati Pujowaskito3 1 General Practitioner at Dustira Hospital, 2Cardiologist at Dustira Hospital, 3 Chairman of Cardiology Department at Dustira Hospital Introduction Heart failure (HF) is a clinical syndrome that present when the heart is unable to pump blood forward at a sufficient rate to meet the metabolic demands of the body. HF results in a clinical syndrome of dyspnea, fatigue, peripheral edema and rales. In CHF patient often occurs ventricular remodeling that leads to induce complications, such as AF. Most patients (more than 50%) with CHF are elderly because of degenerative changes in cardiac structure and function. Case A 75 year- old man with chief complaint was dyspnea on effort, orthopnea, and paroxysmal nocturnal dyspnea since ± 10 days before hospitalized in daily physical activity such as take a bath. Physical examination showed blood pressure 150/90 mmHg, heart rate ± 120 bpm irregularly irregular, respiration 32 times/ min, body temperature 37.3oC, oxygen saturation 93 %, increase JVP, rales at the inferior lungs, and peripheral edema. ECG recording showed rate ± 180 bpm irregularly irregular and ventricular extra systole (VES). He was diagnosed as Congestive Heart Failure (CHF) NYHA Functional Class III and Atrial Fibrillation (AF) with Rapid Ventricular Response with VES. He was treated with furosemide, candesartan, bisoprolol, and warfarin. On the second day of hospitalization, his complaints decreased and ECG showed AF with moderate ventricular response without VES. Discussion AF is often associated with right or left atrial enlargement including heart failure and hypertension. When the rapid ventricular rate occurs in AF, it may compromise cardiac output, resulting in hypotension and pulmonary congestion. The goals of therapy in patients with heart failure are elimination of the acute precipitating cause, management of heart failure symptoms, and modulation of the neurohormonal response to prevent adverse ventricular remodeling in order to prevent/ eliminate its complication. AF is also an important cause of stroke. Key Word Atrial Fibrillation Congestive Heart Failure, Ventricular Remodeling