Open Access

CASE REPORT

Anesthesia-Induced Atrioventricular Block Predicted by Exercise Stress Test: A Case Report

Shotaro Nozaki, Hiroyuki Oikawa, Naofumi F. Sumitomo^*, Kentaro Tomita, Satoshi Narumi

Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan

* Corresponding Author: Naofumi F. Sumitomo. Email:

(This article belongs to the Special Issue: Novel Methods and Techniques for the Management of Congenital Heart Disease)

Structural and Congenital Heart Disease 2026, 21(2), 6 https://doi.org/10.32604/schd.2026.076771

Received 26 November 2025; Accepted 20 April 2026; Issue published 11 June 2026

Abstract

Background: Many anesthetics suppress atrioventricular conduction and may exacerbate atrioventricular block (AVB), which has led to the establishment of pediatric perioperative guidelines. However, the perioperative management of patients with a history of AVB who have recovered to an apparent sinus rhythm remains unclear. Case presentation: We report the case of a 13-year-old girl who developed complete AVB following surgery for congenital heart disease in infancy and subsequently recovered sinus rhythm. She experienced a recurrence of AVB after anesthesia induction for scoliosis surgery. An implantable pacemaker was inserted in infancy after the onset of complete AVB. At age 8 years, sinus rhythm was confirmed at rest; although AVB was still observed during an exercise stress test, the pacemaker was removed at her parents’ request. This case provides important insights into the role of exercise stress testing in the evaluation of atrioventricular conduction. As atrioventricular conduction is strongly influenced by autonomic tone, exercise usually promotes conduction through sympathetic activation and parasympathetic suppression. In contrast, conduction below the His-Purkinje system is not regulated by the autonomic nervous system. Consequently, if abnormalities exist at this level, not all atrial impulses can be conducted to the ventricles during exercise, and AVB may be induced. Conclusion: For patients who appear to have recovered atrioventricular conduction, an exercise stress test may serve as a valuable screening tool to identify residual conduction disorders and assess the risk of intraoperative AVB recurrence.

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