Perioperative management dilemma for first-detected atrial fibrillation on the morning of scheduled non-cardiac surgery: A case report

Abstract

Rationale: Atrial fibrillation is a common perioperative arrhythmia, especially in elderly patients. Although a good amount of literature exists on the perioperative management of patients with pre-existing atrial fibrillation, information on managing a case with first-detected atrial fibrillation on the day of scheduled elective surgery is scarce. Although non-cardiac surgery guidelines in patients with cardiac diseases are well-established, this dilemma is not entirely answered. Patient’s concern: A 75-year-old male patient, anemic with suspected carcinoma and planned for diagnostic cystoscopy and biopsy, presented with irregularly irregular heart rate and palpitation on the morning of scheduled surgery. Diagnosis: First-detected atrial fibrillation with first ventricular rate. Interventions: Intravenous diltiazem 10 mg was given to control ventricular rate, followed by balanced general anesthesia for the intervention. Outcomes: Patient responded to diltiazem; heart rate was controlled. General anesthesia was uneventful except for two brief episodes of hypotension. Atrial fibrillation reverted to sinus rhythm spontaneously the next day. Lessons: The case highlights the dilemma faced in the decision-making based on existing guidelines and successful management of such a rare incident.

Keywords

Atrial fibrillation / Elderly / Decision making / Non-cardiac surgery / Perioperative care / Thrombosis risk

Conflict of interest statement

The authors report no conflict of interest.

Ethical statement

A case report does not require ethical or research cell permission in our institute.

Data availability statement

The data supporting the findings of this study are available from the corresponding author upon request.

Funding

This study received no extramural funding.

Authors’ contributions

All the authors have contributed to the case management, literature search, and draft preparation. The first and the corresponding authors have edited the manuscript. All authors agreed to the final version of the manuscript.

Publisher’s note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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