Rate-Dependent Left Bundle Branch Block in an Ambulatory Surgery Patient: A Case Report.
Ashraf Farag1, Justin Tsai, Sam Deeb
1*Department of Anesthesiology, Texas Tech School of Medicine, Lubbock, Texas; and †Department of Surgery, Texas Tech School of Medicine and Swat Surgical Associates, Lubbock, Texas.
A & a Case Reports
|January 4, 2017
Summary
A patient developed a rate-dependent left bundle branch block (LBBB) during anesthesia induction. This condition resolved with slower heart rates, allowing surgery to proceed after further monitoring.
Area of Science:
- Cardiology
- Anesthesiology
- Electrophysiology
Background:
- Preoperative assessment is crucial for identifying potential anesthetic risks.
- Wide-complex tachycardia and ectopy can complicate anesthetic induction.
- Left bundle branch block (LBBB) can be rate-dependent.
Observation:
- A 52-year-old woman, ASA II, developed wide-complex tachycardia with ectopy post-propofol/succinylcholine induction.
- A new left bundle branch block (LBBB) was noted on ECG at 98 bpm, resolving with slower heart rates.
- The LBBB and ectopy recurred frequently at heart rates >90 bpm over 24 hours.
Findings:
- The patient's new LBBB was diagnosed as rate-dependent.
- Normal troponin levels ruled out acute myocardial injury.
- The patient was deemed stable for cholecystectomy after monitoring.
Implications:
- Rate-dependent LBBB requires careful heart rate management during and after anesthesia.
- Anesthetic protocols may need adjustment for patients with pre-existing or inducible conduction abnormalities.
- This case highlights the importance of continuous cardiac monitoring during ambulatory surgery.
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