Ventricular fibrillation during carotid endarterectomy and bailout stenting: a case report

Yuji Ueda; Masaaki Asamoto; Taro Kariya; Takafumi Akai; Katsuyuki Hoshina; Kanji Uchida

doi:10.1186/s40981-022-00517-4

Ventricular fibrillation during carotid endarterectomy and bailout stenting: a case report

JA Clin Rep. 2022 Mar 31;8(1):26. doi: 10.1186/s40981-022-00517-4.

Authors

Yuji Ueda¹, Masaaki Asamoto², Taro Kariya², Takafumi Akai³, Katsuyuki Hoshina³, Kanji Uchida²

Affiliations

¹ Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. yujini0421@gmail.com.
² Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
³ Department of Vascular Surgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

Abstract

Background: Carotid artery manipulation is not a special technique but reports of intraoperative ventricular fibrillation are rare. The risk of fatal arrhythmias may be hidden behind routine surgical techniques and anesthetic management. We focused on QT prolongation and QT dispersion.

Case presentation: A 77-year-old man underwent carotid endarterectomy and bailout stenting. Although there were no obvious preoperative risk factors for intraoperative ventricular tachyarrhythmia, ventricular fibrillation (VF) had occurred during a maneuver of the carotid artery under hypercapnia. QTc was prolonged from 317 ms before surgery to 458 ms before the onset of VF. QTc dispersion between leads II and III was also increased to 50 ms. Hypomagnesemia was noted after resuscitation by electrical defibrillation, adrenaline, and noradrenaline.

Conclusions: We considered that the combination of multiple risk factors led to the development of ventricular fibrillation. It should be noted that carotid artery manipulation has the potential to cause arrhythmias.

Keywords: Carotid Endarterectomy; Carotid artery manipulation; Fatal arrhythmias; Hypercapnia; Hypomagnesemia; Intraoperative; Perioperative; QT dispersion; QT prolongation; Ventricular fibrillation.