[Arrhythmogenic right ventricular dysplasia revealed during anesthesia]

Bigeminism appearing during pelvic laparoscopy led to the diagnosis of arrhythmogenic right ventricular dysplasia. It is a recently identified specific anatomical and rhythmic entity which gives rise to ventricular tachycardia in the young patient. When anti-arrhythmic drugs become inefficient, surgical treatment may be necessary (ventriculotomy). The anesthetic technique must be chosen so as to avoid setting off the abnormal rhythm. When an expected arrhythmia occurs in the operating theatre, it is inherent either to the surgery, the anaesthetic or the patient. Arguments in favour of cardiac disease are: the common occurrence of cardiac disease, preoperative abnormal ECG or chest X-ray, the mechanism of the arrhythmia (reentry) and the timing of its appearance. This arrhythmia is likely to disappear under light general anaesthesia. Functional abnormalities (anxiety, hypercapnia, hypoxia, acidosis, hypokalemia) should be treated before carrying out other specialized tests, such as cardiac ultrasonography.