Intervention in Undergoing Surgery with Undiagnosed Wolff-Parkinson-White Syndrome: Case Report

Gezy Weita Giwangkancana, Astri Astuti, Dhany Budipratama, Aviryandi Wibawamukti, Fityan Aulia Rahman, Rani Septriana

Abstract


Wolff-Parkinson-White (WPW) syndrome is a commonly undiagnosed cardiac rhythm anomaly in a previously healthy patient who may precipitate malignant arrhythmia under surgical stress. We report successful management of a reconstruction surgery patient who developed cardiac arrest under general anesthesia due to undiagnosed WPW syndrome and a malignant arrhythmia during subsequent emergency surgery. A male patient with no previous history of the co-existing disease, age 23 years old underwent 14 hours of leg reconstruction with a posterior back flap. At the end of the surgery, the patient developed malignant arrhythmia that worsens to pulseless ventricular tachycardia. High-quality resuscitation was conducted and resulted in the return of spontaneous circulation. The patient had to undergo emergency surgery the next day, and another episode of intraoperative malignant arrhythmia was treated with propafenone and diltiazem. The patient underwent ablation postoperatively and, on the 14th day, was discharged without any residual complications. In conclusion, WPW may appear asymptomatic in a healthy young patient. Good anesthesia management and monitoring, knowledge of selective antiarrhythmic drugs and high-quality resuscitation skills can provide an optimal outcome in an unpredicted intraoperative crisis.

Laporan Kasus: Manajemen Pasien Sindrom Wolff-Parkinson-White (WPW) yang Menjalani Tindakan Pembedahan

Sindrom Wolff-Parkinson-White (WPW) adalah kelainan irama jantung yang sering tidak terdiagnosis pada pasien usia muda dan sering tanpa gejala. Stres akibat pembedahan dapat memicu aritmia maligna pada kelainan ini. Kami melaporkan keberhasilan manajemen pada pasien bedah plastik rekonstruksi dalam anestesi umum yang mengalami henti jantung karena sindrom WPW yang tidak terdiagnosis sebelumnya dan terjadi aritmia maligna serupa pada operasi darurat berikutnya. Seorang laki-laki berusia 23 tahun tanpa riwayat penyakit penyerta sebelumnya, menjalani rekonstruksi kaki dengan flap posterior selama 14 jam. Pada akhir pembedahan, pasien mengalami aritimia maligna dan berkembang menjadi ventricular takikardia tanpa nadi. Tindakan resusitasi jantung paru berkualitas tinggi dilakukan dan sirkulasi spontan kembali muncul. Pasien harus menjalani operasi darurat keesokan harinya dan mengalami episode aritmia maligna ulangan intraoperatif yang telah berhasil diidentifikasi pada pemeriksaan pascaoperasi pertama sebagai sindrom Wolff-Parkinson-White. Aritmia maligna tersebut diatasi dengan pemberian propafenon dan diltiazem. Pasien menjalani tindakan ablasi pascaoperasi dan pulang pada hari keempat belas perawatan tanpa gejala sisa. Simpulan, sindrom WPW mungkin tampak asimtomatik pada pasien muda yang sehat. Manajemen anestesi yang baik, pengetahuan mengenai profil berbagai obat antiaritmia serta pelaksanaan tindakan resusitasi berkualitas tinggi dapat memberikan hasil keluaran yang optimal bila terjadi krisis intraoperatif yang tidak diperkirakan sebelumnya.


Keywords


: Arrhythmia, case report, sudden cardiac arrest, tachycardia, Wolff-Parkinson-White syndrome

References


Kasper DL, Fauci AS, Longo DL. Eds. Harrison’s Principles of Internal Medicine. 16th ed. McGraw-Hill Companies. New York, NY; 2005:1350-1.

The National Organization for Rare Disorders (NORD). Wolff-Parkinson-White syndrome (WPW). October 2007.Available at : https://rarediseases.org/rare-diseases/wolff-parkinson-white-syndrome. Accessed on: October 2,2020.

Bengali R, Welles H, Jiang Y. Perioperative Management of the Wolff-Parkinson-White Syndrome. Journal of Cardiothoracic and Vascular Anesthesia, Vol 28, No 5 (October), 2014:1375–86

Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist et al. ESC Guidelines for the management of patients with supraventricular tachycardia. The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC) Developed in collaboration with the Association for European Paediatric and Congenital Cardiology (AEPC). European heart journal. Feb (2020)

Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ et al. ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology. Apr (2016) ;67(13):e27-115.

Palmieri J, Stern T. Lies in the doctor-patient relationship. Prim Care Companion J Clin Psychiatry. 2009; 11(4): 163–8

Graham S, Brookey J. Do patients understand. Perm J. 2008 Summer; 12(3): 67–9

Deviseti P, Pujari V. Spinal Anaesthesia is Safe in a Patient with Wolff-Parkinson-White Syndrome Undergoing Evacuation of Molar Pregnancy. J Clin Diagn Res. 2016 Feb; 10(2): UD01–UD02

Yeung J, Meeks R, Edelson D, Gao F, Soar J, Perkins G. The use of CPR feedback/prompt devices during training and CPR performance: a systematic review. Resuscitation 80(2009) : 743-51

Kodali B, Urman R. Capnography during cardiopulmonary resuscitation : current evidence and future directions. J Emerg Trauma Shock. 2014 Oct-Dec; 7(4): 332–40




DOI: https://doi.org/10.15851/jap.v8n3.2193



 

This Journal indexed by

                               


 
Creative Commons License
JAP is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

 



View My Stats