Unraveling the Enigma of Postablation Rhabdomyolysis: Diagnostic Dilemmas and Therapeutic Strategies.

Rhabdomyolysis is characterized by the breakdown of skeletal muscle tissue and the release of intracellular contents into the circulation, and it poses diagnostic challenges due to its heterogeneous presentation and potential for serious complications. We present a case of a 44-year-old male with a history of hypertension, anxiety, and persistent atrial fibrillation (AF) who developed rhabdomyolysis the morning after a scheduled catheter ablation. He presented with myalgias, muscle cramps, weakness, and brown-colored urine; laboratory studies revealed a creatine phosphokinase (CPK) of 23,757 U/L, hyponatremia, and mildly elevated transaminases despite a normal urinalysis. His CPK improved to below 5,000 U/L after 72 h of intravenous fluid resuscitation, and he was discharged following electrolyte correction. Differential diagnoses considered included propofol infusion syndrome, position-related (pressure-induced) rhabdomyolysis, metabolic myopathy, and malignant hyperthermia (MH), with MH emerging as the most probable etiology given his exposure to succinylcholine and the close temporal relationship between anesthesia and symptom onset. Definitive confirmation was limited by the patient's decision to decline muscle biopsy and genetic testing. Outpatient electromyography did not show a myopathic process, and the patient later tolerated a cardioversion performed under a non-triggering anesthetic protocol without recurrence. This case underscores the importance of maintaining a high index of suspicion for subclinical or atypical MH and anesthesia-induced rhabdomyolysis (AIR) in patients without a prior history of anesthetic complications, and it highlights the diagnostic complexity that arises when confirmatory testing is unavailable or declined. Further research into the mechanisms underlying subclinical MH, along with standardized diagnostic and monitoring protocols for perioperative rhabdomyolysis, is warranted to optimize patient care in similar scenarios.