Intraoperative management of critical arrhythmia

Abstract

The incidence of intraoperative arrhythmia is extremely high, and some arrhythmias require clinical attention. Therefore, it is essential for the anesthesiologist to evaluate risk factors for arrhythmia and understand their etiology, electrophysiology, diagnosis, and treatment. Anesthetic agents reportedly affect normal cardiac electrical activity. In the normal cardiac cycle, the sinoatrial node initiates cardiac electrical activity through intrinsic autonomous pacemaker activity. Sequential atrial and ventricular contractions result in an effective cardiac pumping mechanism. Arrhythmia occurs due to various causes, and the cardiac pumping mechanism may be affected. A severe case may result in hemodynamic instability. In this situation, the anesthesiologist should eliminate the possible causes of arrhythmia and manage the condition, creating hemodynamic stability under proper electrocardiographic monitoring.

Keywords: Anesthesia; Cardiac arrhythmias; Cardiac cycle.

Fig. 1. Electrocardiograph (ECG) and cardiac action potential of the ventricle.

Fig. 2. Atrioventricular block (A), paroxysmal supraventricular tachycardia (B), atrial flutter (C), atrial fibrillation (D).

Fig. 3. Premature ventricular contraction (A), ventricular tachycardia (B), ventricular fibrillation (C).

Fig. 4. Torsade de pointes.

Fig. 5. Artifacts.