Patient with Wolff-Parkinson-White syndrome with intermittent pre-excitation under subarachnoid block for urological surgery

Abstract

Wolff-Parkinson-White (WPW) syndrome is one of the pre-excitation syndromes in which activation of an accessory atrioventricular (AV) conduction pathway leads to bypass the AV node and cause earlier ventricular activation than the normal pathway. We report a patient with intermittent WPW syndrome who repeatedly manifested pre-excitation after subarachnoid block.

Anaesthetic Management of Patient With Mitral Valve Prolapse and Wolf Parkinson White Syndrome for Urological Procedure

“…Central neuraxial blocks have been found to be advantageous and have been successfully used to manage various lower abdominal and perineal surgeries. [7,8,9] The chances of arrhythmias are increased in general anaesthesia because of pain and lighter plane of anaesthesia.…”

erioperative management of patients with pre-excitation syndromes

“…Apart from a 12-lead ECG, Holter monitoring may be useful, especially in intermittent WPW. Echocardiography can reveal congenital cardiac abnormalities that coexist in 7-20% of patients, such as Ebstein's anomaly, valve lesions, cardiac hypertrophy, atrial aneurysms and septal defects [10,11,17]. An EPS may also be needed; the benefit of postponing an elective surgery for EPS testing should be examined.…”

“…An EPS may also be needed; the benefit of postponing an elective surgery for EPS testing should be examined. The capability of rapid anterograde AP conduction increases the risk of sudden death and is an indication for radiofrequency catheter ablation (RFCA) to precede surgery [17]. Diagnosed patients should be carefully assessed preoperatively regarding their symptoms and current treatment, and should be clinically optimised.…”

“…The AV conduction time and functional refractory period may become prolonged and AP conduction facilitated due to unopposed parasympathetic tone [75,76]. Cases of WPW syndrome unmasked due to high levels of spinal blocks are not rare, especially if combined with other vagal stimulants [17,76,77]. Thoracic epidural and single shot spinal anaesthesia are more likely to cause cardiac sympathectomy, thus careful dosing and increased vigilance for a high blockade are required.…”

“…Electrical synchronised cardioversion is indicated for SVT or AF resistant to antiarrhythmic drugs or in cases with extreme tachycardia and/or hypotension/ shock, myocardial ischaemia, heart failure/pulmonary oedema or syncope [17,59,81,97,98]. Immediate defibrillation should be performed in VF or pulseless VT [97].…”