The risk of advanced heart block in surgical patients with right bundle branch block and left axis deviation

The risk of advanced atrioventricular block during anesthesia was studied prosepctively in 44 patients with right bundle branch block and left axis deviation who underwent a total of 52 operations over a 14 month period. All patients had continuous electrocardiographic monitoring throughout anesthesia induction, operation, and surgical recovery. Of the 52 operative procedures, 24 were done under general anesthesia, 11 under spinal, and 17 under local. The preoperative cardiac rhythms were atrial fibrillation in two patients, atrial tachycardia with block in one patient, atrial flutter in one patient, and sinus rhythm in the remaining patients. Temporary pacemakers were inserted preoperatively in six patients, usually because of PR interval prolongation on the preoperative electrocardiogram. There was only one episode of transient complete heart block in 51 of the 52 operative procedures. In two of the six patients with temporary pacemakers, significant pacer-related ventricular irritability occurred. This study indicates that temporary pacemaker insertion is rarely required in patients with chronic right bundle branch block and left axis deviation who require noncardiac surgery.