Development of fast atrial fibrillation in an awake parturient undergoing elective caesarean section

Abstract

A 25 year-old, fit and well, G2P1 woman presented for elective caesarean section under spinal anaesthesia for breech presentation. Following a straight forward spinal anaesthetic and initial progression of surgery, the patient developed atrial fibrillation with a fast ventricular response shortly after delivery and bolus of 5 units of oxytocin. Attempts to restore sinus rhythm with pharmacological methods were unsuccessful and ultimately the patient required electrical cardioversion. An RSI was performed as the patient was still within the first 48 hours post-delivery. Upon laryngoscopy, the patient reverted to sinus rhythm without the need for DC cardioversion. After a short stay in the hospital, the patient was discharged with outpatient ECHO and follow-up awaited. Blood, including thyroid function tests, were unremarkable pre-, intra- and post-operatively. This case report highlights the rarity of development of AF whilst also covering the management of this arrhythmia in the context of the awake parturient.

Keywords

• atrial fibrillation
• caesarean section
• cardioversion
• supraventricular tachycardia