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Updated: Sep 29, 2025
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Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation
Published on: June 20, 2018
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Severe pre-operative sinus bradycardia improved by mediastinal lymph node dissection.
1Department of Anesthesiology, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142, China.
BMC Surgery
|March 23, 2022
Summary
Surgical resection of paratracheal lymph nodes resolved severe sinus bradycardia in a patient with lung cancer. This rare case highlights the impact of vagus nerve compression on heart rate.
Area of Science:
- Cardiology
- Thoracic Surgery
- Anesthesiology
Background:
- A case of bradycardia, rarely reported in literature, improved by surgical resection of paratracheal lymph nodes.
- Pre-operative sinus bradycardia in a patient diagnosed with right upper lobe adenocarcinoma.
Observation:
- Severe sinus bradycardia (HR 28 bpm) occurred during anesthesia induction, unresponsive to atropine.
- Calcified paratracheal lymph nodes (R2 and R4) were noted near the vagus nerve during VATS right upper lobectomy.
- Continuous isoproterenol infusion was required to maintain HR around 50 bpm.
Findings:
- Resection of lymph nodes normalized HR to 60-68 bpm without medication.
- Pathology revealed invasive adenocarcinoma with no lymph node metastasis.
- Post-operative Holter monitoring showed normal sinus rhythm without bradycardia at 1 and 6 months.
Implications:
- Vagus nerve compression by paratracheal lymph nodes can cause persistent sinus bradycardia.
- Clinical experience with temporary pacemaker placement and anesthesia management may be enhanced.
- Surgical intervention can be an effective treatment for bradycardia caused by lymph node compression.
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