[Anesthetic management for on-pump coronary arterial bypass graft in a patient with cardiac resynchronization therapy]

We experienced anesthetic management for on-pump beating coronary arterial bypass graft in a 73-year-old male patient with cardiac resynchronization therapy (CRT), a non-pharmacological therapy in chronic heart failure. Anesthesia was induced and maintained with sevoflurane and fentanyl under intraaortic balloon pump support. When patient's heartbeat exceeded a pacemaker rate, blood pressure decreased to below 60 mmHg. We tried to perform CRT by adjusting its program above his heart rate, and then blood pressure returned to normal levels. After coronary arterial bypass had been established, it was difficult to wean the patient from cardiopulmonary bypass (CPB) because his own heart rate was over 100 beats min(-1). For the purpose of controlling the heart rate, we administered landiolol intravenously. After injecting a total of 2.5 mg of landiolol, his heart rate was reduced and subsequently CRT started to work, which induced a stable hemodynamic condition enough to wean from CPB. According to our clinical experience, it is important to perform a rapid treatment against tachycardia in a patient with CRT Thus, landiolol is useful for such a rapid treatment against tachycardia with maintaining the hemodynamics.