Key result
Sufentanil induction triggers acute AV block deterioration in preexisting bifascicular block requiring temporary pacing.
Why the study?
Coronary artery disease complicated by first-degree atrioventricular block and complete right bundle branch block suggests potential bilateral bundle branch involvement, which substantially increases the risk of severe conduction disturbances during the perioperative period.
Case Report (n=1)
No
In patients with severe coronary artery disease complicated by first-degree atrioventricular block and complete right bundle branch block undergoing high-risk noncardiac surgery, general anesthesia induction (such as with sufentanil) can precipitously worsen conduction block, warranting rigorous rhythm monitoring and pre-established rescue strategies like temporary pacemaker support.
Answers are grounded in this paper and cite their sources.
Sufentanil induction may worsen AV block in bifascicular block with CAD; hypothesis-generating for preemptive pacing protocols.
Coronary artery disease complicated by first-degree atrioventricular block and complete right bundle branch block suggests potential bilateral bundle branch involvement, substantially increasing the risk of severe conduction disturbances during the perioperative period. We report the case of a patient with severe coronary atherosclerosis whose preoperative electrocardiogram revealed first-degree atrioventricular block combined with complete right bundle branch block. Following induction of general anesthesia, the atrioventricular block deteriorated precipitously, prompting postponement of the elective procedure. The patient subsequently underwent successful distal subtotal radical gastrectomy with temporary pacemaker support. This case highlights that anesthesia induction may precipitate or exacerbate atrioventricular block in such patients. For individuals undergoing high-risk noncardiac surgery, comprehensive preoperative assessment of cardiac conduction system function, rigorous dynamic rhythm monitoring, and pre-established rescue strategies including temporary pacemaker placement are warranted.
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Zhao et al. (2026) conducted a case report in Severe coronary artery disease complicated by first-degree atrioventricular block, complete right bundle branch block, and gastric antral carcinoma (n=1). General anesthesia induction with sufentanil and subsequent temporary pacemaker support was evaluated on Perioperative atrioventricular conduction and surgical completion. Sufentanil-based general anesthesia induction precipitated acute atrioventricular block deterioration in a patient with coronary disease and bifascicular block, requiring temporary pacing for surgery.
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