An arrhythmia is an abnormal heart rhythm that occurs when the electrical signals that coordinate the heart’s beats don’t function properly (Mayo Clinic, 2021). There are several types of cardiac arrhythmias, named for the chambers of the heart in which they occur (ventricles or atria) and by what effect they have on the heart’s rhythm; the two major types of cardiac arrhythmia are bradycardia (when the heart beats too slowly) and tachycardia (when the heart beats too quickly) (Columbia Surgery, n.d.; Klein, 2020). Arrhythmias often feel like a racing heart or a fluttering in the chest and are usually harmless. In some cases, however, cardiac arrhythmias can be problematic; when an arrhythmia interferes with blood flow, it can cause damage in the brain, lungs, or other vital organs. Possible causes of arrhythmia include heart disease, aging, stress, tobacco use, and alcohol, among others (Klein, 2020). Additionally, various factors associated with anesthesia influence the occurrence of arrhythmia, making arrhythmia one of the most common cardiovascular complications during anesthesia (Kwon, 2017). Anesthesiology is often acknowledged as the leading medical specialty in addressing issues of patient safety; since the late 1970s, myriad improvements in monitoring and other technologies have been adopted (Gaba, 2000). Even so, further precautions must be taken for patients with arrhythmias.
One of the most common forms of arrhythmia is atrial fibrillation (AF), or irregular heartbeat, in which “the atria (the two small upper chambers of the heart) quiver instead of beating effectively” (Columbia Surgery, n.d.). AF affects 0.4% of the general population and 5-10% of people over the age of 65 (CDC, 2021). In addition, AF occurs in as many as 50% of patients undergoing cardiac operations (Columbia Surgery, n.d.). For that reason, patients with AF benefit from specialized anesthesia care. Depending on a patient’s symptoms, wishes, and medical history, cardiologists manage AF and other arrhythmias in a variety of ways. When surgery is recommended, anesthesiologists must create a plan that considers a particular patient’s overall condition and even their current medications. For example, many patients with AF take blood thinners to prevent stroke, resulting in low blood pressure that requires careful intraoperative monitoring by an anesthesiologist (Columbia Surgery, n.d.).
A procedure known as ablation is often used to treat AF – this surgical approach can take up to six hours, and the anesthesiologist is responsible for monitoring the patient throughout. Sometimes general anesthesia is used, while other times monitored anesthesia (anesthesia that leaves the patient conscious but pain-free) is employed (Yale Medicine, n.d.). Understandably, a lot of planning goes into preparing a patient for the anesthesia portion of surgery for AF. If a patient’s condition is chronic, they will likely undergo pre-admission testing a few days before surgery so that the anesthesiologist can account for potential “debilitating conditions such as difficulty breathing and lying flat, kidney dysfunction, and other abnormal findings” (Yale Medicine, n.d.). If a patient’s condition is acute and the procedure is urgently needed, then the cardiac anesthesiologist is more dependent on their expertise and experience due to having less time available for preoperative testing. Finally, during surgery, several routine monitors are used to track the patient’s vitals. In addition, anesthesiologists use an arterial line, which is “a special catheter that is inserted into an artery in the wrist… that allows for continuous blood pressure measurement and for sampling blood for analysis” (Yale Medicine, n.d.).
Intraoperative arrhythmias and pre-existing arrhythmias like AF elevate risk in the operating room. This makes it essential for anesthesiologists to better understand their etiology and treatment, as well as innovative technologies for intraoperative anesthesia management of arrhythmia.
References
Anesthesia for Atrial Fibrillation. (n.d.). Yale Medicine. Retrieved from https://www.yalemedicine.org/conditions/anesthesia-for-atrial-fibrillation
Atrial Fibrillation and other Arrhythmias. (n.d.). Columbia Surgery. Retrieved from https://columbiasurgery.org/conditions-and-treatments/arrhythmiaatrial-fibrillation
CDC. (2021, September 27). Atrial Fibrillation. Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/atrial_fibrillation.htm
Gaba, D. M. (2000). Anaesthesiology as a model for patient safety in health care. British Medical Journal, 320(7237), 785–788.
Heart arrhythmia. (2021, October 1). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668
Klein, E. (2020, March 18). Everything You Want to Know About Arrhythmia. Healthline. https://www.healthline.com/health/arrhythmia
Kwon, C. H., & Kim, S.-H. (2017). Intraoperative management of critical arrhythmia. Korean Journal of Anesthesiology, 70(2), 120–126. doi:10.4097/kjae.2017.70.2.120
