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Chronic bundle branch block and use of temporary transvenous pacemakers during coronary arteriography

I C Gilchrist1, A Cameron

  • 1Department of Medicine, St. Luke's-Roosevelt Hospital Center, New York.

Catheterization and Cardiovascular Diagnosis
|January 1, 1988
PubMed

Insights

Routine temporary pacing is unnecessary for patients with chronic bundle branch block undergoing coronary arteriography. Most bradyarrhythmias can be managed without pacemakers, and prophylactic pacing may increase ventricular fibrillation risk.

Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • Chronic bundle branch block (BBBC) can predispose patients to bradyarrhythmias.
  • Coronary arteriography is an invasive procedure that may precipitate cardiac events.

Purpose of the Study:

  • To evaluate the necessity of temporary transvenous pacing during coronary arteriography in patients with chronic bundle branch block.
  • To assess the safety and efficacy of managing bradyarrhythmias without prophylactic pacing.

Main Methods:

  • Retrospective analysis of 217 patients with chronic bundle branch block undergoing cardiac catheterization.
  • Comparison of outcomes between patients who received prophylactic right ventricular pacing and those who did not.

Main Results:

  • Only one patient required urgent pacing for high-grade atrioventricular block.
  • Other bradyarrhythmias, including transient asystole and atrioventricular block, were managed without pacemakers.
  • Prophylactic pacing was associated with a higher prevalence of ventricular fibrillation (9% vs 2%; P < 0.05).

Conclusions:

  • Prophylactic transvenous pacing is not warranted for patients with chronic bundle branch block undergoing coronary arteriography.
  • Routine prophylactic pacing may increase the risk of iatrogenic ventricular arrhythmias.

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