Published online Mar 26, 2023. doi: 10.12998/wjcc.v11.i9.2098
Peer-review started: December 26, 2022
First decision: January 12, 2023
Revised: January 18, 2023
Accepted: February 21, 2023
Article in press: February 21, 2023
Published online: March 26, 2023
Processing time: 81 Days and 5.9 Hours
The R-on-T phenomenon is a malignant arrhythmia associated with potentially catastrophic consequences. It may initiate ventricular tachycardia or ventricular fibrillation, which can result in syncope or sudden cardiac death. This manifesta
We herein present a case in which the R-on-T phenomenon was incidentally revealed by 24-h Holter monitoring in a patient diagnosed with sigmoid colon cancer. Careful evaluation and treatment with mexiletine were carried out preoperatively under consultation with a cardiovascular specialist, and surgery was uneventfully performed under general anesthesia after thorough preparation.
Physicians should be vigilant about this infrequent but potentially fatal arrhythmia. Our experience suggests that the anesthetic process can be greatly optimized with careful preparation.
Core Tip: The R-on-T phenomenon is associated with an increased risk of fatal arrhythmia. It may initiate ventricular tachycardia and ventricular fibrillation, and its appearance seem to be associated with a poor prognosis. However, this phenomenon is rarely encountered in the preoperative inpatient setting. The anesthetic management of patients with this particular manifestation poses a great challenge. We herein describe a patient who was scheduled for laparoscopic-assisted sigmoid colon resection when the R-on-T phenomenon was incidentally discovered. Our experience suggests that the anesthetic process can be greatly optimized by detailed preoperative assessment and preparation with interdisciplinary cooperation.