Intermittent left bundle branch block – reversal to normal conduction during general anesthesia

Silva, Ana Maria Oliveira Correia da; Silva, Emília Alexandra Gaspar Lima da

doi:10.1016/j.bjane.2016.11.002

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…LBBB can occur in a transient or intermittent manner, developing under diverse clinical settings, including during anesthesia, due to various etiologies such as blood pressure perturbation, tachycardia, and bradycardia. Conversely, the episodic disappearance of LBBB during anesthesia has rarely been reported [2][3][4]. The presented case shares similarities with three such previously reported cases, as summarized in Table 1.…”

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confidence: 84%

Transient remission of pre-existing left bundle branch block during general anesthesia in a centenarian

et al. 2019

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We present a case of a centenarian patient in whom preexisting left bundle branch block (LBBB) transiently reverted to normal ventricular conduction during general anesthesia. A 104-year-old woman with a history of hypertension, chronic heart failure, and cognitive impairment was admitted for surgical repair of a femoral neck fracture. The standard 12-lead electrocardiogram (ECG) on admission revealed left axis deviation and complete LBBB with a heart rate (HR) of 60 bpm. Echocardiography indicated left ventricular dyssynchrony with an ejection fraction of 51%. Due to her restless and agitated behavior, general anesthesia was selected for surgery.On arrival in the operating room, the patient's blood pressure (BP) was 170/110 mmHg and HR was 110 bpm with a regular rhythm. ECG monitoring showed a wide QRS complex (140 ms) with RsrS pattern (Fig. 1a). Anesthesia was induced with fentanyl, remifentanil, propofol, and rocuronium, followed by insertion of a supraglottic airway, and maintained with desflurane, remifentanil, and fentanyl. Her lungs were mechanically ventilated. Twenty minutes after the commencement of anesthesia, the QRS complex abruptly narrowed to an rSr′ pattern (80 ms) with a HR of 80 bpm and BP of 100/50 mmHg (Fig. 1b). Surgery was commenced after femoral nerve block using levobupivacaine.Intraoperatively, HR, BP, S P O 2 , and end-tidal CO 2 were maintained at 50-80 bpm, 90/40-120/60 mmHg, 99-100%, and 32-43 mmHg, respectively. At the end of the surgery that lasted for 33 min, the QRS complex widened to an RSr pattern (140 ms) at a HR of 50 bpm and BP of 100/60 mmHg (Fig. 1c) for a few minutes.

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confidence: 84%

Transient remission of pre-existing left bundle branch block during general anesthesia in a centenarian

et al. 2019

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“…Smith's modification of Sgarbossa scale is also used clinically but it is time consuming [8]. Intraoperative LBBB diagnosis can be made by various modalities which alter the heart rate (valsalva, carotid massage, administration of atropine, neostigmine, esmolol or propranolol) but it should be done under controlled settings only [9]. Such maneuvers can be more detrimental in patients with cerebrovascular diseases.…”

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confidence: 99%

Critical Heart Rate Dependent LBBB: Need Caution!

Gill¹,

Mudgal²

2022

SCR

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Right bundle branch block (RBBB) and left bundle branch block (LBBB) are commonly seen in geriatric cases posted for surgeries. LBBB usually results from conduction system degeneration or myocardial pathology. LBBB is often associated with hypertension, myocarditis, coronary heart disease, aortic valve disease, cardiomyopathy etc. We report a case of diagnosed LBBB preoperatively posted for emergency spinal decompression. After induction of anaesthesia, the heart rate settled below 77 beats per minute (bpm) and led to reversion of LBBB to normal sinus rhythm. LBBB is a red flag diagnosis to the anaesthesiologist. But the knowledge of critical heart rate is important; below which the rhythm may revert back to normal sinus rhythm. The knowledge to differentiate between myocardial ischaemia and LBBB is the need of the hour.

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“…Some clinical conditions observed in LBBB are coronary artery disease, hypertension, valve disease, cardiomyopathy, congenital heart disease, infective endocarditis, myocarditis along with electrolyte disturbances, such as hyperkalemia. Moreover, drugs, such as hydroxychloroquine, are used for treating LBBB (1) . Being responsible for the ongoing worldwide pandemic, coronaviruses are enveloped viruses with a single positive-stranded RNA genome (2) .…”

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confidence: 99%

Resolution of Left Bundle Branch Block Due To Treatment of COVID-19-Related Myocarditis

Yıldız

Sahin

Parmaksız

et al. 2020

Kosuyolu Heart Journal

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We present the case of a 67-year-old woman with novel coronavirus-infected pneumonia, who was subsequently diagnosed with coronavirus disease 2019 (COVID-19)-related myocarditis and left bundle branch block (LBBB). COVID-19-infected pneumonia treatment, such as oseltamivir, azithromycin, ceftriaxone, and ascorbic acid, may be related to the reduction of myocarditis lesion. Reduction in lesions' size may improve the conduction system; therefore, LBBB can also be resolved in the treatment of COVID-19-infected pneumonia.

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Intermittent left bundle branch block – reversal to normal conduction during general anesthesia

Cited by 3 publications

References 12 publications

Transient remission of pre-existing left bundle branch block during general anesthesia in a centenarian

Transient remission of pre-existing left bundle branch block during general anesthesia in a centenarian

Critical Heart Rate Dependent LBBB: Need Caution!

Resolution of Left Bundle Branch Block Due To Treatment of COVID-19-Related Myocarditis

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