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Complete block below the His bundle induced by left-sided cardiac catheterization
1University of Oklahoma Health Sciences Center, Oklahoma City.
Catheterization and Cardiovascular Diagnosis
|November 1, 1991
Insights
A patient experienced complete heart block during a cardiac catheterization procedure. This block, located in the distal His-Purkinje system, resolved spontaneously without complications.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Electrophysiology
Background:
- Pre-existing conduction abnormalities, such as right bundle branch block and left anterior fascicular block, can predispose patients to further cardiac conduction disturbances.
- Cardiac catheterization, while diagnostic and therapeutic, carries potential risks, including iatrogenic conduction abnormalities.
Observation:
- A patient with documented right bundle branch block and left anterior fascicular block underwent left ventricular catheterization.
- During the procedure, the patient acutely developed complete heart block.
Findings:
- Intracardiac electrograms localized the site of the complete heart block to the distal His-Purkinje system.
- The conduction block was transient and resolved spontaneously following the catheterization procedure.
Implications:
- This case highlights the vulnerability of the distal His-Purkinje system in patients with pre-existing conduction disease during invasive cardiac procedures.
- Understanding the electrophysiological substrate is crucial for managing and preventing conduction abnormalities during catheterization.
- Prompt recognition and monitoring can lead to favorable outcomes, even in cases of complete heart block.
Abstract:
A patient with right bundle branch block and left anterior fascicular block developed complete heart block during passage of a catheter into the left ventricle. Intracardiac electrograms showed the block to be in the distal His-Purkinje system. The block resolved without complications.