Key result
Atropine reverses profound intraoperative bradycardia but precedes emergence VT storm.
Why the study?
Ventricular tachycardia storm during emergence from anesthesia is rare, and the significance of a persistent rhythm abnormality after treating profound intraoperative bradycardia is uncertain.
Case Report (n=1)
No
In patients with prior myocardial infarction, a persistent unexplained rhythm abnormality after atropine treatment for profound intraoperative bradycardia—even with restored heart rate and stable blood pressure—may precede perioperative ventricular tachycardia storm and warrants 12-lead ECG reassessment before emergence from anesthesia.
Persistent abnormal rhythm after atropine for bradycardia may precede VT storm on emergence; this case leaves open whether reassessment improves safety.
Background Ventricular tachycardia (VT) storm during emergence from anesthesia is rare. The significance of a persistent rhythm abnormality after treatment of profound intraoperative bradycardia is uncertain. Case presentation A 60-year-old hemodialysis patient with prior inferior infarction and preserved ejection fraction underwent toe disarticulation. Near the end of surgery, the heart rate fell to about 25 beats/min, with 1:1 atrioventricular conduction. Atropine restored the rate, but not stable sinus rhythm. Five minutes into emergence, monomorphic VT storm began, with no preceding rise in heart rate, blood pressure, or bispectral index. VT persisted or recurred and required multiple shocks; angiography showed patent grafts. The patient survived neurologically intact. Conclusion Heart rate increased after atropine and blood pressure remained stable, but an abnormal rhythm persisted before VT storm developed during emergence. A persistent unexplained rhythm abnormality after treatment of profound bradycardia may warrant rhythm reassessment before emergence.
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Tomiyasu et al. (2026) conducted a case report in Ventricular tachycardia storm during emergence from anesthesia following profound sinus bradycardia in a patient with prior inferior myocardial infarction (n=1). Atropine for intraoperative sinus bradycardia followed by defibrillation, landiolol, and amiodarone for ventricular tachycardia storm was evaluated on Resolution of ventricular tachycardia storm and neurologically intact survival. Atropine 0.5 mg increased heart rate from 25 to >50 beats/min during intraoperative bradycardia, but an abnormal rhythm persisted before a 135 beats/min VT storm developed 5 minutes into emergence.
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