We report the case of a 75-year-old man who suffered an intraoperative asystolic cardiac arrest during elective open repair of an abdominal aortic aneurysm. Return of circulation was achieved following the initiation of temporary right ventricular pacing via a Swan–Ganz pacing catheter. The patient experienced a further episode of refractory asystole in the postoperative period, with subsequent insertion of a permanent pacemaker. This case highlights the role of a Swan–Ganz pacing catheter as a resuscitative measure in refractory intraoperative asystole during major non-cardiac surgery.
RamachandranSKMhyreJKheterpalS, et al. Predictors of survival from perioperative cardiopulmonary arrests: A retrospective analysis of 2,524 events from the Get With The Guidelines-Resuscitation registry. Anesthesiology2013; 119: 1322–1339. doi:10.1097/ALN.0b013e318289bafe
2.
SprungJWarnerMEContrerasMG, et al. Predictors of survival following cardiac arrest in patients undergoing noncardiac surgery: A study of 518,294 patients at a tertiary referral center. Anesthesiology2003; 99: 259–269. doi:10.1097/00000542-200308000-00006
3.
DawsonJVigSChokeE, et al. Medical optimisation can reduce morbidity and mortality associated with elective aortic aneurysm repair. Eur J Vasc Endovasc Surg2007; 33: 100–104. doi:10.1016/j.ejvs.2006.08.002
4.
ChaikofELBrewsterDCDalmanRL, et al. The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines. J Vasc Surg2009; 50(4 Suppl.): S2–S49. doi:10.1016/j.jvs.2009.07.002
5.
PetkerSAhmedG. Asystolic cardiac arrest following pneumoperitoneum from vagal-mediated bradycardia during laparoscopic gynaecologic surgery: A case report. Cureus2025; 17: e88889. doi:10.7759/cureus.88889
6.
AbdallaAElgawireMElgawireA, et al. Bradycardia leading to asystole cardiac arrest during laparoscopic surgical procedure: A rare but critical intraoperative complication. J Am Coll Cardiol2025; 85(12 Suppl.): 3883. doi:10.1016/S0735-1097(25)04367-0
7.
MinSWHwangJM. The incidence of asystole in patients undergoing strabismus surgery. Eye (Lond)2009; 23: 864–866. doi:10.1038/eye.2008.127
8.
Ortiz-PecesLÁlvaro-MartínezMMoreiras-SánchezÁD, et al. Trigeminocardiac reflex in bimaxillary orthognathic surgery: Case review. Med Oral Patol Oral Cir Bucal2025; 30: e523–e527. doi:10.4317/medoral.27062
9.
ShakilHWangAPHorthDA, et al. Trigeminocardiac reflex: Case report and literature review of intraoperative asystole in response to manipulation of the temporalis muscle. World Neurosurg2019; 122: 424–427. doi:10.1016/j.wneu.2018.10.186
10.
LilitsisEPapaioannouAHatzimichaliA, et al. A case of asystole from carotid sinus hypersensitivity during patient positioning for thyroidectomy. BMC Anesthesiol2016; 16: 85. doi:10.1186/s12871-016-0255-5
11.
CzarneckaKJędrzejecMKukiełczyńskaA, et al. Selected medicines that can cause cardiac arrest with asystole. Curr Issues Mol Biol2025; 47: 299. doi:10.3390/cimb47050299
12.
MartinekRM. Witnessed asystole during spinal anesthesia treated with atropine and ondansetron: A case report. Can J Anaesth2004; 51: 226–230. doi:10.1007/BF03019100
13.
MengLRasmussenMAbcejoAS, et al. Causes of perioperative cardiac arrest: Mnemonic, classification, monitoring, and actions. Anesth Analg2024; 138: 1215–1232. doi:10.1213/ANE.0000000000006664
14.
MaddaliMM. Cardiac pacing in left bundle branch/bifascicular block patients. Ann Card Anaesth2010; 13: 7–15. doi:10.4103/0971-9784.58828
15.
KashouAHGoyalANguyenT, et al. Atrioventricular block. In: StatPearls. Treasure Island, FL: StatPearls Publishing, updated 12 February 2024, https://www.ncbi.nlm.nih.gov/books/NBK459147/ (accessed 15 August 2025).
16.
ThompsonBMSteuvenHSTonsfeldtDJ, et al. Calcium: Limited indications, some danger. Circulation1986; 74: IV90-IV93.
17.
International Liaison Committee on Resuscitation. 2005 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Part 4: Advanced life support. Resuscitation2005; 67: 213–247. doi:10.1016/j.resuscitation.2005.09.018
18.
WhiteJDBrownCG. Immediate transthoracic pacing for cardiac asystole in an emergency department setting. Am J Emerg Med1985; 3: 125–128. doi:10.1016/0735-6757(85)90034-8
19.
BarthellETroianoPOlsonD, et al. Prehospital external cardiac pacing: A prospective, controlled clinical trial. Ann Emerg Med1988; 17: 1221–1226. doi:10.1016/s0196-0644(88)80074-x
20.
CumminsROGravesJRLarsenMP, et al. Out-of-hospital transcutaneous pacing by emergency medical technicians in patients with asystolic cardiac arrest. N Engl J Med1993; 328: 1377–1382. doi:10.1056/NEJM199305133281903
