CASE REPORT
The patient was a 44-year-old woman (height 155 cm, weight 62 kg), scheduled for laparoscopic right adrenalectomy for primary aldosteronism. She had no previous history of arrhythmia and did not use any medications causing cardiac rhythm disturbances. On the day before surgery, a PICC (PowerPICC®, Becton, Dickinson and Company, NJ, USA) was inserted via the right brachial-basilic vein and the Sherlock 3CG TCS (Becton, Dickinson and Company, NJ, USA) was used to confirm the correct position of the catheter tip. It was placed 41 cm from the insertion site based on the maximal P-wave on ECG observed after confirmation of the P-wave inversion. The correct position of the tip was then confirmed by chest radiography. After induction of anesthesia, when the patient was placed in left lateral decubitus position with adduction and then internal rotation of her right shoulder and flexion of the elbow, monomorphic nonsustained VT occurred (Fig. 2). With further, almost maximal, internal rotation of the shoulder the arrhythmia ceased and the surgery commenced as planned. Intraoperatively, the right atrial and right ventricular pressures were measured through one of the PICC (Fig. 3) lumens. They indicated respiration-related movements of the catheter tip into the right ventricle; however, no further disturbances in the cardiac rhythm were observed. When the patient was turned back to the supine position after operation, the arrhythmia did not occur, and the post-operative course was uneventful.