Analysis of Atrio-ventricular Junctional Rhythm during General Anesthesia

We examined the incidence of paroxysmal atrio-ventricular junctional rhythm (AVJR) in 27 patients during general anesthesia with enflurane, sevoflurane and isoflurane. The incidence of paroxysmal AVJR was 3.0% for sevof lurane, 1.8% for enflurane and 1.5% for isof lurane, but these differences were not statistically significant. No significant difference in the incidence of AVJR was seen between general anesthesia alone and general anesthesia combined with epidural anesthesia. We classified the AVJR into three patterns: isorhythmic dissociation (pattern 1), wandering pacemaker (Pattern 2) and atrio-ventricular nodal rhythm (Pattern 3). Pattern 3 was seen most frequently. In all the patterns mean arterial pressure was decreased. In pattern 3, heart rate was increased, whereas it remained unchanged in pattern 1 and 2. In pattern 1, blood pressure was most severely decreased, but heart rate did not change. This study suggests that, of the three patterns, the decrease of cardiac output due to the loss of atrial kick was most marked in pattern 1 during general anesthesia.