Korean J Anesthesiol.  2010 Dec;59(Suppl):S58-S61. 10.4097/kjae.2010.59.S.S58.

Paroxysmal atrial fibrillation developed during incomplete epidural anesthesia: A case report

• Choi MJ
• Shin HW
• Choi SU
• Park JY
• Lee HW
• Lim HJ
• Yoon SM
• Chang SH

• KMID: 2237353
• DOI: http://doi.org/10.4097/kjae.2010.59.S.S58

Abstract

Atrial fibrillation (AF) is the most common sustained tachyarrhythmia, and occurs in organic heart disease such as rheumatic, atherosclerotic and hypertensive heart disease. In recent studies, the sympathetic and parasympathetic nervous systems have been shown to have important roles in initiating paroxysmal AF. We report here a patient who developed paroxysmal AF that might be a result of an imbalance of the sympathetic-parasympathetic systems due to epidural anesthesia, and that was potentiated by pain with inadequate analgesia. A 69-year-old woman was scheduled for operation of a right-sided ankle fracture. Twenty minutes after epidural drug injection, paroxysmal AF occurred. Even after intravenous administration of esmolol and digoxin, AF continued. After transfer to the intensive care unit, her heart rate gradually decreased and AF disappeared. During perioperative anesthetic management, the proper preoperative prevention and intraoperative treatment are needed in AF high-risk patients.

Keyword

Atrial fibrillation; Autonomic nervous system; Epidural anesthesia

MeSH Terms

Administration, Intravenous
Aged
Analgesia
Anesthesia, Epidural
Animals
Ankle
Atrial Fibrillation
Autonomic Nervous System
Digoxin
Female
Heart Diseases
Heart Rate
Humans
Intensive Care Units
Parasympathetic Nervous System
Propanolamines
Tachycardia
Digoxin
Propanolamines