[Successful control of rapid heart rate with atrial flutter by intravenous administration of esmolol in a patient after total correction of the tetralogy of Fallot].

Abstract

A 30-year-old woman with atrial flutter after surgical correction of tetralogy of Fallot, underwent gynecological procedure under general anesthesia. Because she had been noted to have atrial flutter and heart failure at 8 weeks' gestation, she was scheduled for dilatation and curettage. Chest X-ray film showed cardiomegaly and pulmonary congestive changes. ECG showed atrial flutter with 3:2 atrio-ventricular conduction rate and complete right branch block. She was anesthetized with propofol infused with target-controlled infusion system, fentanyl and 66% of nitrous oxide under close monitoring and appropriate respiratory management. The quantity of hemorrhage was about 850 ml, and hypovolemia was treated with volume infusion and the use of vasoactive drugs. Soon after emergence from anesthesia, atrial flutter with 1:1 A-V conduction (> 230 bpm) occurred suddenly. Esmolol hydrochloride, 30 mg, was administered. Despite the relatively low doses, rapid control of heart rate was possible in a few minutes and the atrial flutter returned to 2:1 conduction. Although atrial flutter had continued until the discharge, tachyarrhythmia was no longer observed and the heart resumed sinus rhythm 3 month after the operation. The present case suggests that esmolol can be used effectively and safely for controling atrial flutter with rapid ventricular response in a patient after surgical correction of tetralogy of Fallot.

• Authors: Taishi Masamune, Satomi Suzuki, Akihiko Nonaka, Makoto Imamura, Fumiaki Abe
• Journal: Masui. The Japanese journal of anesthesiology (Masui) Vol. 53 Issue 8 Pg. 918-20 (Aug 2004) ISSN: 0021-4892 [Print] Japan
• PMID: 15446684 (Publication Type: Case Reports, English Abstract, Journal Article)

Chemical References

• Adrenergic beta-Antagonists
• Propanolamines
• esmolol

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Adult
• Anesthesia, General
• Atrial Flutter (drug therapy)
• Dilatation and Curettage
• Female
• Humans
• Postoperative Care
• Postoperative Complications (drug therapy)
• Pregnancy
• Pregnancy Complications, Cardiovascular (drug therapy)
• Propanolamines (therapeutic use)
• Tachycardia, Supraventricular (drug therapy)
• Tetralogy of Fallot
• Treatment Outcome