Persistent Supraventricular Tachycardia Following Central Venous Catheter Insertion: When Withdrawal of the Mechanical Stimulus Is Not Enough.

Cardiac arrhythmias are a recognised complication of central venous catheterisation and are usually attributed to mechanical irritation of the endocardium by the guidewire or catheter tip. These arrhythmias typically resolve following withdrawal of the mechanical stimulus. We report a 42-year-old man with heart failure with reduced ejection fraction and diabetic ketoacidosis who developed an abrupt regular narrow-complex tachycardia at approximately 217 beats/min immediately following advancement of a right internal jugular central venous catheter. The arrhythmia was associated with transient hypotension and dizziness and persisted despite removal of both the guidewire and catheter. This case illustrates that catheter manipulation may trigger a sustained supraventricular tachycardia that persists after removal of the mechanical stimulus, particularly in a patient with structural heart disease and metabolic and electrolyte abnormalities. Persistent tachyarrhythmia following catheter withdrawal should prompt assessment of haemodynamic stability and guideline-directed arrhythmia management rather than an assumption of spontaneous resolution.