TY  - EJOU
AU  - Nozaki, Shotaro 
AU  - Oikawa, Hiroyuki 
AU  - Sumitomo, Naofumi F. 
AU  - Tomita, Kentaro 
AU  - Narumi, Satoshi 

TI  - Anesthesia-Induced Atrioventricular Block Predicted by Exercise Stress Test: A Case Report
T2  - Structural and Congenital Heart Disease

PY  - 2026
VL  - 21
IS  - 2
SN  - 3071-1738

AB  - 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.
KW  - Exercise stress test; anesthetics; atrioventricular block; perioperative care; temporary pacemaker; case report

DO  - 10.32604/schd.2026.076771