Bilateral bundle-branch block developing after surgical repair of ventricular septal defects may progress to intermittent complete heart block, suggesting a potential need for early electrical pacing.
Extended monitoring may be prudent after VSD repair with bilateral bundle-branch block; this case leaves open optimal pacing thresholds.
A case of postoperative bilateral bundle-branch block is described. After complete correction of tetrad of Fallot, the patient showed varying degrees of heart block for the first i8 months after operation, normal sinus rhythm for the next year, and then a reversion to intermittent complete heart block. A pacemaker was implanted three years after operation when symptoms appeared in conjunction with periods of slow heart rate, and when the implications of postoperative bilateral bundle-branch block were appreciated. To date, this conduction disturbance has been recognized in arteriosclerotic heart disease, but, with the exception of one report, has not been discussed in relation to the surgical repair of ventricular septal defects. When bilateral bundle-branch block develops after heart operation, it is probably best to initiate electrical pacing of the heart immediately.
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Potter et al. (1971) studied this question.
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