[Complete heart block induced by insertion of a pulmonary artery catheter]

We report a case of complete heart block induced by insertion of a pulmonary artery catheter (PAC). A 74-year-old man was scheduled for off-pump coronary artery bypass grafting. The preoperative electrocardiogram revealed complete left bundle-branch block (LBBB). General anesthesia was induced with intravenous administration of midazolam 5.3 mg, fentanyl 110 microg and rocuronium 32 mg. General anesthesia was maintained with oxygen, air and sevoflurane. After a PAC was inserted via the right internal jugular vein and when it entered the right ventricle, complete heart block (CHB) associated with severe bradycardia occurred. Cardiopulmonary bypass (CPB) was required during the surgery and temporary epicardial pacing was instituted for weaning from CPB. Cardiac rhythm was restored to complete LBBB without any treatment postoperatively, but CHB recurred 9 seconds after the removal of PAC. The electrophysiologic study performed afterward showed an intact conduction pathway. Right bundle-branch block (RBBB) is one of complications induced by pulmonary artery catheterization. In the patients with underlying LBBB, transient RBBB produces CHB that could produce hemodynamic compromise. Therefore, we should carefully consider the indication of PAC in the patients with preexisting LBBB.