03 - JULY - Vol. - 33, No. - 3, 2021 (200) CASE REPORTS Abstract: Though a common procedure, central venous access is related to morbidity and mortality of patients. Common cardiac complications caused by central venous catheters include premature atrial and ventricular contractions. But development of atrial fibrillation with haemodynamic instability is quite rare. We are reporting a patient who developed atrial fibrillation with hypotension while inserting central venous catheter through right subclavian vein by landmark technique. Patient was managed with DC cardioversion. Careful insertion of central venous catheter & prompt management of its complication is crucial to avoid catastrophe. Keywords: Central venous catheter, Atrial fibrillation, General anaesthesia. (J Bangladesh Coll Phys Surg 2021; 39: 200-204) DOI: https://doi.org/10.3329/jbcps.v39i3.54168 Central Venous Catheter induced Atrial Fibrillation-A Case Report M AHMED a , A NESSA b , MAA SALEK c a. Brig Gen Masud Ahmed, Adviser Anaesthesiologist, Combined Military Hospital, Dhaka. b. Col Azizun Nessa, Classified Medical specialist, Combined Military Hospital, Dhaka. c. Lt. Col. Md. Al Amin Salek, Classified Neurosurgeon, Combined Military Hospital, Dhaka. Address of Correspondence: Brig Gen Masud Ahmed. FCPS, Department of Anaesthesiology, CMH, Dhaka, Bangladesh. Email: masud742@gmail.com Received: 14 October, 2020 Accepted: 18 May, 2021 Introduction: Establishment of central venous catheter (CVC) in critically ill patients of intensive care unit, operating room, emergency & casualty and in renal dialysis centre is now a routine procedure both for monitoring and therapeutic purposes. But it can invite some serious complications like cardiac dysrhythmias, pneumothorax, vessel/nerve injuries, thromboembolism and infection. 1 Strict attention to insertion technique and correct line tip position can reduces the risk of dire complications like cardiac arrest and even death if not immediately intervened. So, clinicians must remain aware and prepared with management plan if there is any emergency. Here we report a case of first diagnosed atrial fibrillation (AF) with haemodynamic instability during placement of a CVC in an anaesthetized patient scheduled for emergency craniotomy for intracerebral haemorrhage. Informed written consent of the patients next of kin (wife) and approval from institutional review board were obtained. Case report: Mr. X aged 46 years (weight  73 kg, height  174 cm) with no known comorbidity or history of cardiac events, scheduled for emergency craniotomy to remove blood clot for right sided intracerebral haemorrhage (ICH). In the operating room his baseline parameters were as follows: pulse  44/min (regular), blood pressure (BP)  186/113 mm of Hg with Glasgow coma scale (GCS) score  E 1 M 5 V 2 (8/15). There was left sided hemiparesis (2/5). All routine investigations including electrocardiogram (ECG) were within normal limit except serum potassium level which was slightly low (3.2 mmol/L). General anaesthesia was administered following the standard protocol. After left radial arterial cannulation, junior resident tried inserting CVC (7Fr/20cm /tri channel) through right subclavian vein using landmark technique under ECG monitoring. While introducing guidewire there were irregular RR intervals on ECG monitor. So, guidewire was withdrawn approximately 6 cm and CVC was fixed at 12 cm. But dysrhythmias persisted. On monitor his heart rate was 150 -190 /min (irregular) and