Complete atrioventricular block with bradycardia after craniotomy

Shun-Chin Yang1, Wen-Kuei Chang, Hui-Bih Yuan

  • 1Department of Anesthesiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.

Insights

An 82-year-old patient developed complete atrioventricular block after surgery. Prompt pacemaker insertion restored heart rate, highlighting the need for rapid management of this rare complication.

Area of Science:

  • Neurology
  • Cardiology
  • Neurosurgery

Background:

  • Craniotomy is a major neurosurgical procedure.
  • Postoperative cardiac complications, though rare, can be severe.

Observation:

  • An 82-year-old male developed complete atrioventricular block (CAVB) with severe bradycardia one hour post-craniotomy.
  • The patient had no prior history of syncope or arrhythmias.

Findings:

  • Emergency transvenous pacemaker placement successfully restored the patient's heart rate.
  • Cardiac enzyme assays, echocardiography, and digoxin levels ruled out myocardial infarction, injury, or drug toxicity.

Implications:

  • Neurogenic heart disorders, heightened vagal tone, and advanced age may predispose patients to CAVB after craniotomy.
  • Complete atrioventricular block is a rare but potentially catastrophic complication of craniotomy requiring immediate intervention.

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