CASE REPORT: DELAYED ONSET MALIGNANT ARRHYTHMIA SECONDARY TO ELECTROCUTION

Abstract

High-voltage electrical injuries can precipitate acute cardiac instability. Malignant arrhythmias may arise days to weeks later. Reports of delayed‐onset bradyarrhythmia after electrocution are scarce and optimal surveillance strategies remain ill-defined.

Case Presentation: A 28-year-old male electrician sustained a 10,000-volt electrocution to the left upper limb - with entry and exit burns at the hand and forearm. He was hemodynamically stable on arrival; electrocardiography (ECG) and serum electrolytes were normal. Because of the high-voltage exposure he was admitted to the intensive-care unit for continuous monitoring. Rapidly progressive compartment syndrome mandated emergent fasciotomy. This was followed by guillotine amputation of the right hand when tissue perfusion proved non-viable. Post-operatively he developed stump infection requiring debridement and split-skin grafting.

Four weeks after injury the patient acutely deteriorated with profound bradycardia (heart rate 30 beats min⁻¹) and hypotension. Repeat ECG indicated multiple bradycardic runs with absent P-waves - consistent with malignant bradyarrhythmia. Immediate intravenous atropine restored perfusion and he was transferred to a cardiac care unit. Echocardiography demonstrated only trace mitral regurgitation; a 24-h Holter confirmed bradyarrhythmia with a minimum heart rate of 39 beats min⁻¹ and 59 % of total beats in bradycardia. Supportive therapy, β-blockade and an ACE inhibitor were initiated. The patient remained stable under prolonged telemetry and was discharged with plans for outpatient cardiology follow-up and rehabilitation of the amputated limb.

Conclusion: This case illustrates that life-threatening bradyarrhythmia can manifest weeks after apparently uncomplicated high-voltage electrocution. Prolonged cardiac monitoring and a multidisciplinary approach are essential to detect and manage delayed electrical injury sequelae.