Perioperative management dilemma for first-detected atrial fibrillation on the morning of scheduled non-cardiac surgery: A case report

Rationale: Atrial fibrillation is a common perioperative arrhythmia, especially in elderly patients. Although a good amount of literature exists on the perioperative management of patients with pre-existing atrial fibrillation, information on managing a case with first-detected atrial fibrillation on the day of scheduled elective surgery is scarce. Although non-cardiac surgery guidelines in patients with cardiac diseases are well-established, this dilemma is not entirely answered. Patient’s concern: A 75-year-old male patient, anemic with suspected carcinoma and planned for diagnostic cystoscopy and biopsy, presented with irregularly irregular heart rate and palpitation on the morning of scheduled surgery. Diagnosis: First-detected atrial fibrillation with first ventricular rate. Interventions: Intravenous diltiazem 10 mg was given to control ventricular rate, followed by balanced general anesthesia for the intervention. Outcomes: Patient responded to diltiazem; heart rate was controlled. General anesthesia was uneventful except for two brief episodes of hypotension. Atrial fibrillation reverted to sinus rhythm spontaneously the next day. Lessons: The case highlights the dilemma faced in the decision- making based on existing guidelines and successful management of such a rare incident.