Preoperative Cardiac Clearance for Back Surgery
Yes, this patient is cleared for back surgery from a cardiac standpoint. Her AVNRT has been successfully ablated with complete resolution of symptoms, normal cardiac function on recent echocardiogram, and stable sinus rhythm on recent EKG, indicating excellent procedural outcome and minimal perioperative cardiac risk 1.
Rationale for Clearance
Successful AVNRT Ablation Outcome
- Catheter ablation of AVNRT achieves >95% success rates with <1% risk of AV block, making it a highly effective curative procedure 1.
- This patient demonstrates complete symptomatic resolution post-ablation with no recurrent palpitations, indicating successful slow pathway modification 1.
- Her recent EKG showing normal sinus rhythm at 69 bpm confirms stable cardiac electrical activity without evidence of recurrent arrhythmia or conduction abnormalities 1.
Normal Cardiac Structure and Function
- Her echocardiogram demonstrates preserved left ventricular function (EF 53%), normal chamber sizes, and no valvular abnormalities, eliminating concerns for structural heart disease that would increase perioperative risk 1.
- The absence of systolic heart failure is particularly important, as this would have contraindicated certain medications and increased surgical risk 1.
Low Risk of Perioperative Arrhythmia Recurrence
- The risk of late AV block after successful AVNRT ablation is essentially zero beyond the first week post-procedure 2.
- Long-term follow-up data spanning 3-8 years shows no patients developed new AV block related to prior ablation during extended follow-up 2.
- Any intraprocedural or early post-procedural AV block would have manifested within 7 days of her ablation, which occurred months ago 2.
Perioperative Considerations
ADHD Medication Management
- Stimulant medications for ADHD can theoretically trigger AVNRT in susceptible patients, but this risk is eliminated post-ablation since the arrhythmogenic substrate has been destroyed 3.
- Her stimulant therapy does not require modification for surgery, as the slow pathway has been successfully ablated 3.
Anesthesia Implications
- No special cardiac monitoring beyond standard ASA guidelines is required for this patient 1.
- Vagal maneuvers would have been first-line treatment for acute AVNRT episodes, but are unnecessary given her curative ablation 1.
- Emergency adenosine availability is not specifically indicated, though standard ACLS medications should always be accessible 1.
Critical Pitfalls to Avoid
- Do not delay surgery for additional cardiac testing—her recent echocardiogram and EKG provide sufficient cardiac assessment 1.
- Do not empirically start AV nodal blocking agents (beta blockers, calcium channel blockers) for perioperative prophylaxis, as she has no indication for these medications post-successful ablation 1, 4.
- Ensure anesthesia team is aware of her cardiac history, but emphasize the curative nature of AVNRT ablation to avoid unnecessary perioperative cardiac interventions 1.
Follow-up Plan
- Continue routine cardiology follow-up in 6 months as planned, with no need for accelerated post-surgical cardiac evaluation unless new symptoms develop 1.
- Her history of cocaine misuse and former smoking are cardiovascular risk factors requiring long-term management, but do not impact immediate surgical clearance 1.