Development of rapid atrial fibrillation with a wide QRS complex after neostigmine in a patient with intermittent Wolff-Parkinson-White syndrome.
We report the case of a 67-yr-old man with intermittent Wolff-Parkinson-White (WPW) syndrome in whom neostigmine produced life-threatening tachyarrhythmias. The patient was scheduled for microsurgery for a laryngeal tumour. When he arrived in the operating room, the electrocardiogram showed normal sinus rhythm with a rate of 82 beat min-1 and a narrow QRS complex which remained normal throughout the operative period. On emergence from anaesthesia, the sinus rhythm (87 beat min-1) changed to atrial fibrillation with a rate of 80-120 beat min-1 and a normal QRS complex. We did not treat the atrial fibrillation because the patient was haemodynamically stable. Neostigmine 1 mg without atropine was then administered to antagonize residual neuromuscular block produced by vecuronium. Two minutes later, the narrow QRS complexes changed to a wide QRS complex tachycardia with a rate of 110-180 beat min-1, which was diagnosed as rapid atrial fibrillation. As the patient was hypotensive, two synchronized DC cardioversions of 100 J and 200 J were given, which restored sinus rhythm. No electrophysiological studies of anticholinesterase drugs have been performed in patients with WPW syndrome. We discuss the use of these drugs in this condition.
Kadoya
T
T
Department of Anaesthesia, Nippon Steel Yawata Memorial Hospital, Kitakyushu, Japan.
Seto
A
A
Aoyama
K
K
Takenaka
I
I
D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology*; D002800:Cholinesterase Inhibitors / Q000009:adverse effects*; D004562:Electrocardiography; D006801:Humans; D008297:Male; D009388:Neostigmine / Q000009:adverse effects*; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications*
D002800:Cholinesterase Inhibitors; D009388:Neostigmine