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Sinus Arrest and Asystole Caused by a Peripherally Inserted Central Catheter.
MedLine Citation:
PMID:  24286255     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Transient bradycardia in the critical care setting is frequently caused by hypoxemia or oropharyngeal manipulation. Central lines have been associated with a variety of cardiac arrhythmias, but sinus arrest and asystole have not been previously reported.
METHODS: A 38-year-old woman with multisystem organ failure had several episodes of prolonged sinus arrest, slow junctional escape rhythm, and periods of asystole lasting over 6 seconds. The cause of the repetitive bradyarrhythmia was evaluated by clinical observation including the response to parasympatholytic agents, by detailed analysis of rhythm strips, and review of cardiac imaging studies.
RESULTS: The episodes of bradycardia did not coincide with orotracheal manipulation, were not prevented by escalating doses of glycopyrrolate, and were not accompanied by AV conduction disturbance as is frequently seen during a transient increase in vagal tone. Review of the patient's chest X-ray and chest CT revealed that the tip of a peripherally inserted central catheter migrated to the vicinity of the sinoatrial node. Removal of the catheter resulted in prompt resolution of the episodes of sinus arrest.
CONCLUSIONS: This case demonstrates that migration of a peripherally inserted central catheter to the sinoatrial node can provoke prolonged sinus bradycardia, sinus arrest and asystole.
Authors:
Allison Nazinitsky; Melody Covington; Laszlo Littmann
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-11-29
Journal Detail:
Title:  Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc     Volume:  -     ISSN:  1542-474X     ISO Abbreviation:  Ann Noninvasive Electrocardiol     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607443     Medline TA:  Ann Noninvasive Electrocardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2013 Wiley Periodicals, Inc.
Affiliation:
Department of Internal Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA.
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