We report a case in which WPW (Wolff-Parkinson-White)-type preexcitation syndrome arose unexpectedly immediately after induction of general anesthesia on a 25-yr-old man who had another rare cardiac arrhythmia, parasystole. His preoperative ECG showed ventricular bigeminy and a delta wave was observed after induction of anesthesia with fentanyl, midazolam and propofol. Anesthesia was maintained with propofol, fentanyl and nitrous oxide. The intraoperative ECG showed varying and temporary responsiveness to drugs such as atropine, lidocaine and ephedrine. After we started to infuse the dobutamine, the delta wave, ventricular bigeminy disappeared on the intraoperative ECG. We should consider the influence of anesthesia-related agents on arrhythmia, and aim to prevent and manage tachyarrhythmias caused by this syndrome.
Anesthesia ; Anesthesia, General* ; Arrhythmias, Cardiac ; Atropine ; Dobutamine ; Electrocardiography ; Ephedrine ; Fentanyl ; Humans ; Lidocaine ; Midazolam ; Nitrous Oxide ; Parasystole* ; Pre-Excitation Syndromes* ; Propofol ; Tachycardia ; Wolff-Parkinson-White Syndrome

Parasystole is of special interest among the disturbances of ectopic impulse formatioo. First, a parasystolic arrhythmia is of clinical importance because the ventricular origin ordinarily indicates the presence of organic heart disease. Second, parasystole, although not rare, is frequently overlooked because it is difficult to be differentiated from extrasystole. In this paper a ventricular parasystole is presented. A 48 year-old woman was seen with an irregular pulse rate not accompanying cardiac symptoms or signs. The chest radiograph failed to show cardiomegaly. E.K.G. revealed the dominant rhythm of sinus origin with intermittent ventricular parasystolic beats. The basic rhythm was sinus with a rate of 83 per minute. The coupling interval varied between 0.52 & 0.7 second. The shortest, calculated interectopic interval ranged from 45.2 to 49.7 (These numbers represent hundreds of a second). Occasional ventricular fusion beats appeared. She was uneventfully nephrectomized under general anesthesia with halothane-N2O-O2for left renal empyema of tuberculosis. She dispensed well with any antiarrhythmic agent during admission.
Anesthesia* ; Anesthesia, General ; Arrhythmias, Cardiac ; Cardiac Complexes, Premature ; Cardiomegaly ; Empyema ; Female ; Heart Diseases ; Heart Rate ; Humans ; Middle Aged ; Parasystole* ; Radiography, Thoracic ; Tuberculosis