CASE REPORT
The patient was a 44-year-old woman (height 155 cm, weight 62 kg),
scheduled for laparoscopic right adrenalectomy for primary
aldosteronism. She had no previous history of arrhythmia and did not use
any medications causing cardiac rhythm disturbances. On the day before
surgery, a PICC (PowerPICC®, Becton, Dickinson and
Company, NJ, USA) was inserted via the right brachial-basilic vein and
the Sherlock 3CG™ TCS (Becton, Dickinson and Company,
NJ, USA) was used to confirm the correct position of the catheter tip.
It was placed 41 cm from the insertion site based on the maximal P-wave
on ECG observed after confirmation of the P-wave inversion. The correct
position of the tip was then confirmed by chest radiography. After
induction of anesthesia, when the patient was placed in left lateral
decubitus position with adduction and then internal rotation of her
right shoulder and flexion of the elbow, monomorphic nonsustained VT
occurred (Fig. 2). With further, almost maximal, internal rotation of
the shoulder the arrhythmia ceased and the surgery commenced as planned.
Intraoperatively, the right atrial and right ventricular pressures were
measured through one of the PICC (Fig. 3) lumens. They indicated
respiration-related movements of the catheter tip into the right
ventricle; however, no further disturbances in the cardiac rhythm were
observed. When the patient was turned back to the supine position after
operation, the arrhythmia did not occur, and the post-operative course
was uneventful.