Iatrogenic Transient Complete Heart Block in a Preexisting LBBB

Abstract

Catheter induced cardiac arrhythmia is a well-known complication encountered during pulmonary artery or cardiac catheterization. Injury to the cardiac conducting system often involves the right bundle branch which in a patient with preexisting left bundle branch block can lead to fatal arrhythmia including asystole. Such a complication during central venous cannulation is rare as it usually does not enter the heart. The guide wire or the cannula itself can cause such an injury during central venous cannulation. The length of the guide wire, its rigidity, and lack of set guidelines for its insertion make it theoretically more prone to cause such an injury. We report a case of LBBB that went into transient complete heart block following guide wire insertion during a central venous cannulation procedure.

Guidewire-induced asystole complicating a right internal jugular catheter placement in a patient with pre-existing left bundle branch block: A case report

“…Fascicular block may be due to longitudinal dissociation of fibers in the bundle of His but the exact proven mechanism is still unknown. 2,4 Careful insertion of guidewire to less than 22 cm decreases the incidence of complications by 70%. So, it is better to consider the safe limit up to 18 cm.…”

“…So, it is better to consider the safe limit up to 18 cm. 3,4,10 Lee et al have a prospective study comparing the incidence of cardiac arrhythmias with three different lengths of guidewire insertion (15, 17.5, and 20 cm) during right IJV catheter insertion. Cardiac arrhythmia was reported in 26%, 35%, and 65% with 15, 17.5, and 20 cm respectively.…”

“…Most patients were female. 2–7 Imran et al 3 reported recurrent supraventricular tachyarrhythmia (SVT) in a patient aged 17 years diagnosed as acute lymphoblastic leukemia after a peripherally inserted central venous catheter (PICC) for chemotherapy. SVT did not recur after PICC was with pulled out few centimeters.…”

“…Fascicular block may be due to longitudinal dissociation of fibers in the bundle of His but the exact proven mechanism is still unknown. 2,4 Careful insertion of guidewire to less than 22 cm decreases the incidence of complications by 70%. So, it is better to consider the safe limit up to 18 cm.3,4,10 Lee et al have a prospective study comparing the incidence of cardiac arrhythmias with three different lengths of guidewire insertion (15, 17.5, and 20 cm) during right IJV catheter insertion.…”

New-onset complete right bundle branch block following successful balloon mitral valvuloplasty for mitral stenosis: a new phenomenon?

“…If the RBBB had developed in the background of pre-existing left bundle branch block (LBBB), the patient would have developed complete heart block (CHB) requiring temporary pacing. 11 If the CHB did not resolve, the patient would have needed permanent pacing. Thus, adequate precautions and patient counselling are a must before performing BMV in a patient with pre-existing LBBB on ECG.…”