Intraoperative Episodic Paroxysmal Atrial Tachycardia in a Patient with Structurally Normal Heart with Fracture Femur – A Technical Report

A 70-year-old female with a left femur fracture underwent percutaneous pinning surgery. Her medical history included controlled diabetes without other notable comorbidities. Preoperative evaluations, including electrocardiogram and echocardiogram (ECHO), showed normal results, and routine laboratory tests were also unremarkable. Anesthesia management involved premedication with intravenous midazolam, a peripheral nerve block using ultrasound with 25 mL of 0.25% bupivacaine. The authors administered 1.6 mL of 0.5% hyperbaric bupivacaine intrathecally at the L3-4 level, ensuring effective spinal anesthesia up to a level of T12. During the 45-min surgery, the patient experienced paroxysmal atrial tachycardia (PAT) approximately every 3–4 min presenting with a heart rate exceeding 160 beats/min each episode for, a minute, followed by recurring episodes. Blood pressure changes were minimal and difficult to record as the episodes were transient. The anesthetic team promptly administered 150 mg of intravenous amiodarone, successfully converting the rhythm to normal sinus. Throughout the procedure, vital signs were monitored, and hemodynamics remained stable. Postoperatively, the patient was transferred to the recovery unit, where a subsequent ECHO indicated normal cardiac function. She was prescribed amiodarone (100 mg bid) and metoprolol (25 mg bid) to manage her atrial tachycardia, leading to a smooth recovery. She was discharged on postoperative day 3 in stable condition and scheduled for follow-up within a week to reassess her cardiac status. In our case, there was no arrhythmogenic instigation with a structurally normal heart. This case highlights the significance of vigilant intraoperative monitoring in geriatric patients, particularly regarding the risks of in the surgical setting. The paroxysms with warm up and cool off phenomenon pointed to PAT than atrioventricular nodal reentrant tachycardia. Pharmacological strategies, such as the use of amiodarone, can effectively manage these episodes while maintaining hemodynamic stability. Cardioversion and adenosine remain the primary choices in handling such conditions still we used amiodarone. Follow-up care remains essential for ongoing management of any potential cardiac complications.