Onset of lone atrial fibrillation during labor under epidural analgesia

Practice standards recommend that the induction of epidural analgesia for labor begin with a test dose of local anesthetic with epinephrine. During the test dose period and following anesthetic administration, the anesthesiologist measures the parturient's pulse with continuous pulse oximetry to help detect the intravascular placement of the epidural catheter as evidenced by the abrupt onset of tachycardia.

We report the onset of tachycardia in a healthy parturient following induction of continuous epidural analgesia. The tachycardia was ultimately diagnosed as lone atrial fibrillation-a finding not previously reported in the literature.

We initially thought the diagnosis portended undetected cardiac disease, but further assessment found no cardiac abnormalities.