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Published on: February 11, 2022
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.
Abstract:
We report an 82-year-old male patient who developed complete atrioventricular block (CAVB) with severe bradycardia 1 hour after craniotomy. After emergency placement of a transvenous pacemaker, the patient's heart rate was restored. Serial assays of serum cardiac enzymes, echocardiography and serum digoxin concentration did not show evidence of myocardial infarction, myocardial injury, or drug toxicity. Tracing back past history, neither syncope nor arrhythmia of any form was noted. A neurogenic heart disorder, high vagal tone, and aging possibly contributed to this cardiac event in this patient. CAVB, although uncommon, is a disastrous complication following craniotomy, and needs aggressive and instantaneous management.
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