Complete heart block--an underappreciated serious complication of central venous catheter placement

Area of Science:

• Cardiology
• Critical Care Medicine
• Medical Procedures

Background:

• Central venous catheter (CVC) placement is a frequent bedside procedure for critically ill patients.
• Millions of CVCs are inserted annually in the US, with potential complications ranging from minor bleeding to life-threatening events.
• Cardiac arrhythmias, including bundle-branch blocks, are known risks during guidewire manipulation.

Observation:

• This report details a rare case of complete heart block occurring during CVC placement.
• The patient had a pre-existing left bundle-branch block.

Findings:

• Complete heart block developed during the guidewire insertion phase of CVC placement.
• The complication is likely due to trauma to the right bundle branch, exacerbated by the patient's underlying left bundle-branch block.

Implications:

• This case underscores the potential for serious cardiac complications during CVC insertion, even in patients with pre-existing conduction abnormalities.
• Awareness and careful guidewire manipulation are crucial to mitigate the risk of iatrogenic heart block.
• Further investigation into monitoring and prevention strategies for cardiac complications during CVC placement may be warranted.