Sudden cardiac arrest due to coronary vasospasm in a patient with Wolff-Parkinson-White syndrome during brain surgery: a case report

Yuka Matsuki,Kenji Shigemi,Maki Mizogami

doi:10.1186/s40981-019-0233-2

Abstract

BackgroundWolff-Parkinson-White (WPW) syndrome has the risk of sudden cardiac death. Without appropriate treatment, coronary vasospasm is also a potentially fatal condition due to ischemia-induced ventricular fibrillation. A rare case of cardiac arrest due to coronary vasospasm during general anesthesia in a patient with pre-existing WPW syndrome is presented.Case presentationA 55-year-old man was scheduled for brain surgery under general anesthesia. During surgery, the ECG monitor showed ST segment elevation followed by sustained ventricular tachycardia and the patient’s blood pressure was unmeasurable. Since pseudo-VT with WPW syndrome was suspected, pilsicainide was administered. A few weeks later, a spasm provocation test with acetylcholine was performed, which showed complete spastic occlusion of the right coronary artery.ConclusionsA rare case of cardiac arrest during surgery in a patient with WPW syndrome, possibly caused by coronary vasospasm, was described.

Highlights

Wolff-Parkinson-White (WPW) syndrome has the risk of sudden cardiac death
Wolff-Parkinson-White (WPW) syndrome is an electrical conduction abnormality in which atrial impulses are transmitted to the ventricle by an accessory pathway, and it presents the risk of sudden cardiac death associated with paroxysmal atrial fibrillation (PAF), so-called pseudo-ventricular tachycardia [1, 2]
The patient was taken to the operating room without which showed complete spastic occlusion of the right coronary artery, and this confirmed the possible diagnosis of the intraoperative ST elevation due to coronary vasospasm

Summary

Introduction

Wolff-Parkinson-White (WPW) syndrome has the risk of sudden cardiac death. Without appropriate treatment, coronary vasospasm is a potentially fatal condition due to ischemia-induced ventricular fibrillation. Conclusions: A rare case of cardiac arrest during surgery in a patient with WPW syndrome, possibly caused by coronary vasospasm, was described. Background Wolff-Parkinson-White (WPW) syndrome is an electrical conduction abnormality in which atrial impulses are transmitted to the ventricle by an accessory pathway, and it presents the risk of sudden cardiac death associated with paroxysmal atrial fibrillation (PAF), so-called pseudo-ventricular tachycardia (pseudo-VT) [1, 2].

Results

Conclusion