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Related Experiment Videos

Complete atrioventricular block during anesthesia.

K Mamiya1, J Aono, M Manabe

  • 1Department of Anesthesiology, Kochi Medical School, Japan. mamiyak@med.kochi-ms.ac.jp

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|April 21, 1999
PubMed
Summary
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A patient with asymptomatic atrioventricular block and bifascicular block developed complete heart block during anesthesia. This life-threatening condition was successfully managed with transesophageal ventricular pacing.

Area of Science:

  • Anesthesiology
  • Cardiology
  • Electrophysiology

Background:

  • A 67-year-old male presented with asymptomatic first-degree atrioventricular block and bifascicular block (right bundle branch block and left anterior hemiblock).
  • The patient was scheduled for microvascular decompression under general anesthesia.

Observation:

  • During anesthesia induction and maintenance with sevoflurane and isoflurane, the patient developed a sudden, severe hypotensive episode.
  • Simultaneously, the electrocardiogram (ECG) revealed an abrupt transition from sinus rhythm to complete atrioventricular block.

Findings:

  • Pharmacological interventions (atropine, isoproterenol) and transcutaneous pacing were ineffective in restoring cardiac rhythm.
  • Transesophageal ventricular pacing was successfully implemented, stabilizing the patient's hemodynamics.

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Implications:

  • This case highlights the potential for asymptomatic atrioventricular and bifascicular blocks to progress to complete heart block during general anesthesia.
  • Transesophageal pacing offers a viable and effective rescue strategy for managing intraoperative complete heart block when other methods fail.