Bradycardic peri-arrest after electrical cardioversion for atrial fibrillation: a case report

Electrical cardioversion can precipitate prolonged bradycardia and cardiac arrest when the sinoatrial node is dysfunctional, and the escape rhythms from the atrioventricular node and ventricles fail to take over. We report the case of an elderly male who rapidly progressed into bradycardic peri-arrest after electrical cardioversion for persistent atrial fibrillation. Despite the immediate initiation of intravenous atropine and transcutaneous pacing, 2 minutes of cardiopulmonary resuscitation with further boluses of atropine and adrenaline were required before the return of spontaneous circulation. The patient was transferred to the intensive care unit, and a permanent pacemaker was implanted before discharge. Advanced age, long duration of atrial fibrillation, previous aortic valve replacement, use of anti-arrhythmic drugs, and intravenous propofol bolus were all contributing factors to this event. We summarise the relevant clinical features, risk factors, and management considerations, in the hope of promoting awareness of this rare complication of a common procedure.