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Ventricular standstill complicating left heart catheterization in the presence of uncomplicated right bundle branch

R D Gaglani1, A A Turk, M R Mehra

  • 1Mount Carmel Medical Center, Columbus, Ohio 43222.

Catheterization and Cardiovascular Diagnosis
|November 1, 1992
PubMed

Insights

Complete heart block occurred unexpectedly during a cardiac procedure in a patient with a pre-existing right bundle branch block (RBBB). This rare complication was caused by catheter contact with the left bundle branch and resolved spontaneously.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Right bundle branch block (RBBB) is a common electrocardiographic finding.
  • Cardiac catheterization, particularly coronary artery cannulation, is a standard diagnostic and interventional procedure.
  • Potential complications during catheterization, though rare, require careful consideration.

Observation:

  • An unusual case of complete heart block was observed during attempted right coronary artery cannulation.
  • The patient had a pre-existing, uncomplicated right bundle branch block.
  • The complication arose from inadvertent contact of the Judkin's right coronary catheter with the left bundle branch.

Findings:

  • The complete heart block was transient and occurred due to mechanical impingement of the catheter.
  • The catheter's transient slip across the aortic valve led to left bundle branch engagement.
  • The heart block resolved spontaneously without any lasting adverse effects.

Implications:

  • Highlights a rare but significant complication of right coronary artery catheterization in patients with RBBB.
  • Emphasizes the importance of operator awareness regarding potential anatomical interactions during catheter manipulation.
  • Suggests the need for vigilance and prompt recognition of conduction abnormalities during interventional procedures.

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