Kosin Med J.  2019 Jun;34(1):65-71. 10.7180/kmj.2019.34.1.65.

Persistent Complete Atrioventricular Block after Induction of General Anesthesia in a Healthy Patient

  • 1Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea. yuvi1981@naver.com


A 38-year-old female patient had bradycardia in the preoperative electrocardiogram (ECG), and she showed severe bradycardia, with the heart rate (HR) under 40 beats per minute (bpm) even after arrival in the operating room. Immediately after endotracheal intubation, ventricular tachycardia with HR over 200 bpm occurred, but it disappeared voluntarily. The surgery was postponed for additional cardiac evaluation because of the persistent severe bradycardia. On postanesthesia day 2, complete atrioventricular (AV) block appeared. We expected spontaneous recovery over 2 weeks, but the complete AV block persisted. A permanent pacemaker was eventually inserted, and the patient was discharged without other complications on day 4 after insertion of the pacemaker. We report this case because complete AV block has commonly occurred in patients with risk factors such as first AV block, secondary AV block, or bundle branch block, but complete AV block has occurred despite the absence of arrhythmia in this patient.


Atrioventricular block; Bradycardia; General anesthesia

MeSH Terms

Anesthesia, General*
Arrhythmias, Cardiac
Atrioventricular Block*
Bundle-Branch Block
Heart Rate
Intubation, Intratracheal
Operating Rooms
Risk Factors
Tachycardia, Ventricular


  • Fig. 1 Preoperative ECG showing sinus bradycardia with heart rate at 46 beats per minute. ECG, electrocardiogram.

  • Fig. 2 ECG obtained in the immediate postanesthesia period shows a 2:1 AV block. The red arrows indicate P-waves. ECG, electrocardiogram; AV, atrioventricular.

  • Fig. 3 ECG obtained on postanesthesia day 2 shows a complete AV block. The red arrows indicate P-waves. ECG, electrocardiogram; AV, atrioventricular.


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