title: Alteration of fatal 1:1 conducted atrial flutter to less conducted ratio by landiolol infusion.
abstract: An 84-year-old male patient with a past history of atrial-flutter-fibrillation and dementia underwent an urgent femoral neck fracture surgery. Preoperative electrocardiography demonstrated atrial flutter (AFL) with ventricular conduction at a ratio of 2:1-4:1, and transthoracic echocardiography showed severe left ventricular dysfunction with Ejection Fraction of 14.6 %. Femoral nerve block and Lateral femoral cutaneous nerve block with sedation was planned for the surgery. Upon entry to the operating room, ECG showed 2:1 conducted AFL at the rate of 128 beats min(-1). Due to the stimulation of urethral catheter insertion, it has altered to 1:1 conducted AFL. Loading dose of landiolol hydrochloride 7.5 mg followed by 1.5-3 μg/kg/min continuous administration was given, which had decreased the conduction ratio to 2:1 without causing hypotension. A further episode of 1:1 conducted AFL occurred when the pin was inserted to the thighbone, which caused circulatory collapse. Additional bolus dose of landiolol immediately altered it to 2:1 before operating cardioversion and stabilized the hemodynamics. He maintained AFL with 2:1 conduction thereafter, and 1:1 conduction was never seen postoperatively even after discontinuation of landiolol.
authors.affiliation: Department of Anesthesiology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan. junkolumiere@gmail.com.
authors.forename: Junko
authors.initials: J
authors.lastname: Takata
authors.affiliation: Department of Anesthesiology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Haruyama
authors.affiliation: Department of Anesthesiology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Arashi
authors.affiliation: Department of Anesthesiology, Tokyo Metropolitan Police Hospital, 4-22-1 Nakano, Nakano-ku, Tokyo, 164-8541, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Mae
mesh_terms: D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology; D001282:Atrial Flutter / Q000188:drug therapy*; D004562:Electrocardiography; D006801:Humans; D008297:Male; D009025:Morpholines / Q000008:administration & dosage*; D014508:Urea / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
chemical_list: D009025:Morpholines; C077049:landiolol; D014508:Urea
keywords: Atrial flutter; Atrioventricular conduction; Landiolol; Tachycardia