Asystole in young athletic women during breast augmentation: A report of three cases

Reported herein are three cases of spontaneous bradycardia progressing to asystole during routine breast augmentation in healthy, adult female patients with a history of endurance training and resting bradycardia (heart rate<60 beats per minute). The incidence of this phenomenon is minimally reported and virtually unexplained in literature. Our goal is to alert the plastic surgery community of the possibility of these events occurring without warning in athletic patients, attempt to explain these findings, and provide a plan of action to minimize morbidity and mortality in these patients. The most severe case was that of a 38-year-old female who became severely bradycardic progressing to asystole during routine breast augmentation. She had no history of any medical problems, but did have a resting heart rate of <60. Glycopyrrolate, an antimuscarinic agent, was given and chest compressions started. After 10-20 s of chest compressions the patient's normal sinus rhythm resumed. Two other cases are also reported, although these patients responded to antimuscarinic agents without requiring chest compressions. Both were endurance athletes with a resting heart rate of <60. Bradycardia caused by a vagal response during surgery is not uncommon and routinely treated successfully with administration of atropine-like agents. Bradycardia progressing to frank asystole is rare and has not been reported in young, otherwise healthy, aesthetic surgery patients. This report should serve to alert the plastic surgeon to the possibility of this situation occurring and how to treat it successfully, especially in the outpatient or office-based surgery setting. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.