In a 71-year-old woman developing intraoperative atrial fibrillation during thoracoscopic lobectomy, dexmedetomidine was ineffective and caused hemodynamic instability, whereas amiodarone restored sinus rhythm.
Case Report (n=1)
In a case of intraoperative new-onset atrial fibrillation during thoracic surgery, dexmedetomidine was ineffective and caused hemodynamic instability, whereas amiodarone successfully restored sinus rhythm postoperatively.
Atrial fibrillation (AF) is a prevalent perioperative complication associated with lung surgery, contributing to an elevated risk of adverse postoperative outcomes. However, instances of new-onset intraoperative Atrial fibrillation (IOAF) remain infrequently documented. In this report, we present a case of intraoperative new-onset atrial fibrillation occurring during thoracoscopic partial lung resection. Additionally, we examine the risk factors, preventive strategies, and therapeutic interventions for atrial fibrillation, with the objective of enhancing prevention and management of this condition in the perioperative setting. A 71-year-old female patient was scheduled to undergo a thoracoscopic left upper lobectomy due to a ‘left upper lung mass.’ Preoperative electrocardiogram showed occasional atrial premature beats, and cardiac ultrasound indicated left ventricular diastolic dysfunction. During the intraoperative dissection of the hilar lymph nodes, the patient suddenly developed rapid atrial fibrillation with a heart rate of 113 beats per minute, accompanied by pulse deficit. Immediately suspend the surgical operation, but after intravenous administration of dexmedetomidine, the patient’s rhythm did not convert to sinus rhythm, and hemodynamic instability occurred. After stabilizing blood pressure with vasoactive drugs, intravenous amiodarone was given to control the ventricular rate. The patient was transferred to the ICU postoperatively and successfully restored sinus rhythm after subsequent amiodarone treatment. New-onset atrial fibrillation during surgery is a complication that requires attention in thoracic surgery. The novelty of this report lies in: (1)providing a detailed description of the negative clinical experience in which dexmedetomidine was ineffective in this scenario and led to hemodynamic instability, contrasting with previous case reports; (2) proposing a pragmatic strategy of controlling heart rate during surgery and delaying cardioversion until after surgery; (3)emphasizing that elderly women, left lung lobe resection (involving hilar lymph node dissection), and preoperative diastolic dysfunction should also be considered as potential risk factors.
Zuo et al. (Tue,) conducted a case report in Intraoperative new-onset atrial fibrillation (n=1). Dexmedetomidine followed by amiodarone was evaluated on Rhythm conversion and hemodynamic stability. In a 71-year-old woman developing intraoperative atrial fibrillation during thoracoscopic lobectomy, dexmedetomidine was ineffective and caused hemodynamic instability, whereas amiodarone restored sinus rhythm.