Cardiac tachyarrhythmias and anaesthesia: General principles and focus on atrial fibrillation

Abstract

Cardiac tachyarrhythmias are encountered commonly during the perioperative period and need to be promptly identified and appropriately managed by the anaesthesiologist. This review intends to highlight important aspects of these tachyarrhythmias and explore a temporal relationship between common medications employed in the perioperative period and their causation. Mechanisms of initiation of tachyarrhythmias, drugs that can trigger those, as well as their diagnosis and management, are also parts of the current review. Cardiac tachyarrhythmias may not always require treatment, and sometimes, aggressive management can trigger more serious types of arrhythmias. A thorough understanding of these tachyarrhythmias and their pathogenesis enables adopting a more objective approach, eschewing risks of inappropriate or unnecessary management strategies. We performed a MEDLINE search using combinations of MeSH terms such as ‘cardiac’, ‘arrhythmias’, ‘anaesthesia’, ‘perioperative’, ‘tachyarrhythmias’ and ‘anaesthetic implications’. We reviewed the relevant publications with regard to cardiac tachyarrhythmias occurring in the perioperative period.

Nonsustained ventricular tachycardia during outpatient anesthesia: a case report

“…According to the Advanced Cardiac Life Support guideline 2020 ACLS tachycardia algorithm, if hemodynamic compromise occurs in VT patients, synchronized cardioversion should be performed immediately [ 8 ] (supplement1). In patients who are otherwise stable, the clinical benefits of prompt cardioversion in the emergency department are less clear [ 9 ]. In this case, when VT was detected, we prepared an Automatic External Defibrillator (AED).…”

Ultrasound-Guided Sciatic and Femoral Block in Patient with Recent Embolism Stroke Undergo Amputation Above the Knee

“…The use of halothane during anesthesia induction and maintenance has been associated with various arrhythmias, including nodal, atrial, and ventricular tachycardia. 11 Duma et al suggested that corrected QT interval (QTc) prolongation occurs after both spinal and general anesthesia have continued postoperatively. Sevoflurane anesthesia has also been correlated with QTc interval prolongation.…”

Life-Threatening Cardiac Arrhythmias during Anesthesia and Surgery

“…Cardiac electroversion includes cardioversion (synchronized shocks) or defibrillation (nonsynchronized shocks) of hemodynamically unstable patients, which use high-energy capacitor discharges to simultaneously depolarize all excitable myocardium to terminate arrhythmias. It is highly effective and avoids the potential complications of drug therapy [20]. Defibrillation or unsynchronized cardioversion is indicated in any patients with pulseless ventricular tachycardia or ventricular fibrillation whereas synchronized cardioversion is utilized for the treatment of persistently unstable tachyarrhythmias in patients without loss of pulse.…”