Successful use of iv diltiazem to control perioperative refractory complex atrial tachyarrhythmias in a patient with pneumoconiosis.
OBJECTIVE
To present a patient with pneumoconiosis who developed a complex, life-threatening atrial tachyarrhythmia during anesthesia. Intravenous diltiazem was effective in controlling the ventricular rate and hemodynamics after failure of other antiarrhythmic drugs and direct current cardioversion.


METHODS
A 79-yr-old man with pneumoconiosis complicated by cor pulmonale suffered from gout-related cellulitis of the left lower limb. Debridement of the left gangrenous big toe was carried out under general anesthesia. During anesthesia, a wide-QRS tachycardia occurred suddenly and a complex atrial tachyarrhythmia was later diagnosed. Hemodynamics deteriorated despite aggressive treatment with lidocaine, verapamil, direct current cardioversion, magnesium, digoxin and amiodarone. Correction of the underlying respiratory acidosis was not sufficient to control the rapid ventricular response. Eventually, iv diltiazem adequately controlled the rapid ventricular rate and quickly improved the deteriorating hemodynamics.


CONCLUSIONS
Life-threatening complex atrial tachyarrhythmias may occur in patients with chronic lung diseases perioperatively. Intravenous diltiazem was effective in the management of complex atrial tachyarrhythmia in a patient with underlying cor pulmonale.
Tsou
Chi-Hsiang
CH
Department of Respiratory Therapy, Taipei Veterans General Hospital and National Yang-Ming University, Taiwan.
Chiang
Chern-En
CE
Liou
Jiing-Tarng
JT
Hsin
Shi-Tai
ST
Luk
Hsiang-Ning
HN
D000368:Aged; D000768:Anesthesia, General; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004110:Diltiazem / Q000627:therapeutic use*; D004562:Electrocardiography; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D019990:Perioperative Care; D011009:Pneumoconiosis / Q000503:physiopathology* / Q000601:surgery*; D013612:Tachycardia, Ectopic Atrial / Q000188:drug therapy*
D002317:Cardiovascular Agents; D004110:Diltiazem