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Sinus arrest and asystole caused by a peripherally inserted central catheter
Allison Nazinitsky1, Melody Covington, Laszlo Littmann
1Department of Internal Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA.
Summary
A migrated central venous catheter can cause severe bradycardia and sinus arrest in critically ill patients. Prompt removal of the catheter resolved these dangerous cardiac events, highlighting a rare but serious complication.
Area of Science:
- Critical Care Medicine
- Cardiology
- Medical Devices
Background:
- Transient bradycardia in critical care is often due to hypoxemia or oropharyngeal manipulation.
- Central venous catheters are linked to various arrhythmias, but sinus arrest and asystole are not previously reported.
Observation:
- A patient with multisystem organ failure experienced recurrent prolonged sinus arrest and asystole.
- Bradyarrhythmias were not associated with orotracheal manipulation or vagal tone indicators.
Findings:
- Chest imaging revealed a peripherally inserted central catheter tip near the sinoatrial node.
- Removal of the migrated catheter promptly resolved the sinus arrest episodes.
Implications:
- Peripherally inserted central catheter migration to the sinoatrial node can cause significant bradycardia and asystole.
- This case highlights a rare mechanical complication of central venous catheters requiring prompt recognition and intervention.
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