Ventricular fibrillation following eyeball pressure in a case of paroxysmal supraventricular tachycardia

Reflex anoxic seizures ('white breath-holding'): nonepileptic vagal attacks.

“…Although children have died during strabismus surgery with the oculo-cardiac reflex implicated (Sorensen and Gilmore, 1956;Stephenson, 1974), I can find no documentation of a fatality in an awake child. Landman and Ehrenfeld (1952) reported 'nearly fatal' ventricular fibrillation' after ocular compression for supraventricular tachycardia, but there was by presumption heart disease, and inspection of their illustrations suggests not fibrillation but ventricular tachycardia at worst. One unsubstantiated ancedotal warning is to be found in the literature: 'I am told that experts in the techniques of unarmed combat recognise that severe pressure on the eyes can cause syncope, and ifviolent enough, death' (Mallinson and Coombes, 1960).…”

Reflex disturbances of cardiac rhythm during ophthalmic surgery.

“…Sorenson and Gilmore (1956) suggested two mechanisms leading to cardiac arrest -either bradycardia leading to sinus arrest, or more rarely extrasystoles and ventricular fibrillation, both responses occurring when the ocular muscles were being mobilized. Landman and Ehrenfeld (1952) described ventricular fibrillation resulting from eyeball pressure used in an attempt to abolish an established arrhythmia.…”

Ocular compression a century on: time for a thumbs‐off approach?

“…Intra-operative recordings have shown that the OCR is a graded phenomenon as a function of tension applied to the extraocular muscles (Ohashi et al 1986), likely with a polysynaptic pathway to the heart. OC has long been used by cardiologists as one of the vagal manoeuvres for converting supraventricular tachycardia to sinus rhythm, and complications attributed to eyeball compression are confined to this group of patients (Landman andEhrenfeld 1952, Mathis et al 1982). In the investigation of the developing autonomic nervous system in normal newborns and infants OC has proved to be a valuable tool.…”

“…OC has long been used by cardiologists as one of the vagal manoeuvres for converting supraventricular tachycardia to sinus rhythm, and complications attributed to eyeball compression are confined to this group of patients (Landman and Ehrenfeld 1952, Mathis et al 1982).…”