Rikako Takahashi, Ryosuke Kawanishi, Nami Kakuta, Hiroki Yonezawa, Hiroya Endo and Katsuya Tanaka : Severe bradycardia with cardiac arrest caused by test stimulation during the second vagus nerve stimulator implantation: A case report, Circulation Control, 45, 1, 39-42, 2024.
(Summary)
Vagus nerve stimulation (VNS) is used to treat drug-resistant epilepsy. We report a case of intraoperative severe bradycardia and cardiac arrest during a second VNS implantation. No cases of bradycardia during the second VNS implantation have been reported. <br> The patient underwent the first VNS implantation before and experienced no intraoperative bradycardia. A mechanical error of the VNS was discovered, and the second operation was scheduled. General anesthesia was scheduled with supporting by a prophylactic pacing defibrillator to manage bradycardia during VNS. After exchanging the electrodes on the left vagus nerve, test stimulations were performed. We observed an increase in the PR interval on the electrocardiogram (ECG) during the test stimulation and severe bradycardia with cardiac arrest during the main stimulation, which required shortterm chest compressions and percutaneous pacing. After discontinuing stimulation, the pulse rate recovered immediately. We conclude that continuous ECG monitoring intraoperative is crucial, even if the first VNS implantation was uneventful.