Incomplete left bundle branch block as an artefact caused by the Nuss procedure for pectus excavatum

Abstract

We describe the common finding of a reversible incomplete ILBBB after Nuss surgery. The reason for these ECG changes remain unclear. Since cardiac ischaemia, damage, or perioperative irritation of the pericardium is improbable and the alteration of the anatomic thoracic situation remains after bar explantation, we suspect an artefact through alteration of the electric field by the steel bar. Practitioners dealing with patients after Nuss procedure should be aware of this most probably harmless finding.

Cardiopulmonary arrest during the Nuss procedure: case report and review

“…The two fatal cases were both due to sudden cardiac arrest (Table ), one of which appeared to have involved arrhythmia due to preexisting heart disease (mitral valve prolapse). Because pectus excavatum is often associated with a Brugada‐type electrocardiographic pattern and because patients with a pectus bar may develop arrhythmia such as incomplete left bundle branch block, the patient in this case might have had primary arrhythmia or arrhythmia secondary to the Nuss procedure. It is important, therefore, to pay attention to arrhythmic episodes before and after the Nuss procedure.…”

Presyncope in a Patient Status Post Pectus Excavatum Repair

“…Some patients have conduction abnormalities, such as bundle branch block and Brugada phenocopy. [7][8][9] A negative portion of the p wave in V 1 (not LAE) and complete or incomplete RBBB are associated with anatomical severity as indicated by the Haller index (the ratio of the transverse diameter [the horizontal distance of the inside of the rib cage] and the anteroposterior diameter [the shortest distance between the vertebrae and sternum]). 10,11 Our patient displayed nearly all of these electrocardiographic features with the novel exception of a bifascicular block, which has not been described before.…”