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Postoperative episodic left bundle branch block.

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Area of Science:

  • Cardiology
  • Anesthesiology
  • Electrophysiology

Background:

  • Transient left bundle branch block (LBBB) is occasionally observed during physical exertion, in both healthy individuals and those with coronary artery disease.
  • The perioperative occurrence of LBBB, particularly in the absence of cardiac ischemia, requires further investigation.

Purpose of the Study:

  • To report a case of transient left bundle branch block (LBBB) occurring perioperatively in a patient without a history of coronary artery disease.
  • To highlight the importance of recognizing transient LBBB in the absence of physiological stress or cardiac ischemia during the perioperative period.

Main Methods:

  • Case report of a 64-year-old woman undergoing Nissen fundoplication.
  • Preoperative exercise-tolerance test, intraoperative electrocardiogram (ECG) monitoring, and postoperative ECGs.
  • Assessment of cardiac enzymes and clinical symptoms.

Main Results:

  • Preoperative exercise-tolerance test revealed LBBB without ischemic symptoms.
  • Intraoperative ECG showed normal sinus rhythm.
  • Postoperative ECGs demonstrated persistent LBBB in the absence of clinical symptoms or physiological stress; cardiac enzymes were negative.

Conclusions:

  • Transient left bundle branch block (LBBB) can manifest perioperatively without underlying cardiac ischemia.
  • Anesthesiologists must be vigilant for transient LBBB, even in asymptomatic patients without known cardiac disease.
  • This case underscores the need for awareness of non-ischemic causes of perioperative LBBB.