What is the clinical evidence from this study?

Study design: Case Report. Population: Atrioventricular block (n=1). Intervention: Total intravenous anesthesia (propofol, fentanyl, remifentanil). Primary outcome: Development of complete atrioventricular block.

What question did this study set out to answer?

To explore the relationship between exercise stress tests and anesthesia-induced atrioventricular block in pediatric patients.

June 12, 2026Structural and Congenital Heart Disease0 citationsOpen Access

Anesthesia-Induced Atrioventricular Block Predicted by Exercise Stress Test: A Case Report

SNShotaro NozakiYokohama University of Pharmacy HOHiroyuki OikawaTohoku University NSNaofumi F. SumitomoKeio University

Key Result

A 13-year-old girl with a history of AVB developed complete AVB following induction of total intravenous anesthesia, a risk that was predicted by a prior exercise stress test.

Key Points

To explore the relationship between exercise stress tests and anesthesia-induced atrioventricular block in pediatric patients.
Case report analysis of a pediatric patient undergoing anesthesia management.
Assessment of atrioventricular conduction during anesthesia based on exercise stress test results.
Review of existing pediatric perioperative guidelines.
Identification of atrioventricular block linked to specific anesthetic agents during the perioperative period.
Recommendations for incorporating exercise stress tests into preoperative evaluations for pediatric patients at risk.
Highlighting the need for more comprehensive perioperative monitoring strategies.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A 13-year-old girl with a history of congenital heart disease and apparent recovery from complete AVB who experienced recurrent AVB after anesthesia induction.

Exposure

Total intravenous anesthesia (induction with propofol 2 mg/kg, fentanyl 2.5 µg/kg, and rocuronium 1 mg/kg; maintenance with propofol and remifentanil) and temporary pacemaker insertion for scoliosis surgery.

Outcome

Development of intraoperative atrioventricular block and subsequent recovery of sinus rhythm.

An exercise stress test may serve as a valuable preoperative screening tool to identify residual infranodal conduction disorders and assess the risk of anesthesia-induced AVB recurrence in patients with a history of AVB.

Limitations

Difficult to determine whether any single anesthetic agent was primarily responsible for the development of AVB.
ECG findings during exercise may be affected by thoracic anatomy.
The relationship between exercise intensity or heart rate at which AVB develops and the risk of perioperative recurrence remains unclear.

Abstract

Background: Many anesthetics suppress atrioventricular conduction and may exacerbate atrioventricular block (AVB), which has led to the establishment of pediatric perioperative guidelines. However, the perioperative managemen... | Find, read and cite all the research you need on Tech Science Press

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