An unusual cause of rapid atrial fibrillation.

A 75-yr-old man who presented with stenotic lower-third esophageal cancer was anesthetized for iterative palliative endoscopic dilatation. In the operating room, a case of welltolerated new onset rapid atrial fibrillation (AF) (170 beats min) was diagnosed. This diagnosis prompted us to postpone the procedure. In the morning, an electrocardiogram revealed the absence of cardiac rhythm abnormalities; however, fluid expansion and intravenous administration of magnesium sulfate 1.5 g proved ineffective. In the recovery room, the anesthesiologist performed a transthoracic echocardiogram (TTE) that revealed an extrinsic compression of the posterior left atrial wall by a circular hyperechogenic structure (Fig. 1, panel B). A computed tomography scan confirmed that the structure was an esophageal stent that had been invaded by the tumour (Fig. 2). The left ventricular ejection fraction was approximately 50%, which allowed the physicians to attempt cardioversion by intravenous administration of amiodarone 300 mg. The patient’s heart rate normalized within one hour, and general anesthesia was then performed. New onset AF with poor tolerance or uncontrolled heart rate in the preoperative setting is a rare condition, and