Key result
A 38-year-old female patient with preoperative sinus bradycardia developed a persistent complete atrioventricular block requiring a permanent pacemaker after induction of general anesthesia.
Why the study?
Complete AV block typically develops in patients with preexisting conduction risk factors, but its occurrence in a patient without prior arrhythmia had not been commonly observed.
Case Report (n=1)
No
General anesthesia with sevoflurane and remifentanil can trigger persistent complete AV block requiring a permanent pacemaker in patients with preoperative sinus bradycardia.
May warrant vigilance during anesthesia induction in preoperative sinus bradycardia; leaves open predictors of persistent AV block.
A 38-year-old female patient had bradycardia in the preoperative electrocardiogram (ECG), and she showed severe bradycardia, with the heart rate (HR) under 40 beats per minute (bpm) even after arrival in the operating room. Immediately after endotracheal intubation, ventricular tachycardia with HR over 200 bpm occurred, but it disappeared voluntarily. The surgery was postponed for additional cardiac evaluation because of the persistent severe bradycardia. On postanesthesia day 2, complete atrioventricular (AV) block appeared. We expected spontaneous recovery over 2 weeks, but the complete AV block persisted. A permanent pacemaker was eventually inserted, and the patient was discharged without other complications on day 4 after insertion of the pacemaker. We report this case because complete AV block has commonly occurred in patients with risk factors such as first AV block, secondary AV block, or bundle branch block, but complete AV block has occurred despite the absence of arrhythmia in this patient.
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Byeon et al. (2019) conducted a case report in Persistent complete atrioventricular block (n=1). General anesthesia (sevoflurane and remifentanil) was evaluated. A 38-year-old female patient with preoperative sinus bradycardia developed a persistent complete atrioventricular block requiring a permanent pacemaker after induction of general anesthesia.
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