Key result
Left heart catheterization triggers persistent complete AV block requiring permanent pacing in bifascicular block.
Why the study?
Complete atrioventricular block induced during left heart catheterization is very rare and its clinical characteristics need clarification.
Case Report (n=1)
Left heart catheterization can rarely induce complete atrioventricular block in patients with pre-existing RBBB and hemiblock, necessitating emergency pacing equipment on standby.
May indicate risk of persistent AV block during left heart catheterization in bifascicular block; leaves open incidence and preventive strategies.
A 75-year-old male underwent cardiac catheterization for frequent ventricular premature contractions and reduced left ventricular function. ECG on admission showed complete right bundle branch block (RBBB) and left anterior hemiblock. Right heart catheterization was performed uneventfully, but complete atrioventricular block (CAVB) occurred suddenly when a pig-tail catheter was inserted into the left ventricle. Electrophysiological study identified this CAVB as HV block, and demonstrated HV prolongation in sinus rhythm. The coronary angiogram revealed no obstructive lesion or spasm with ergonovine. The reproducibility of the CAVB was demonstrated. The final CAVB developed and persisted for more than one week, requiring the implantation of a permanent pacemaker (DDD). Complete atrioventricular block induced during left heart catheterization is very rare. Pre-existing RBBB with left anterior or posterior hemiblock and reduced left ventricular function may be common factors in patients with this condition. Emergency pacing equipment should always be on-line when left heart catheterization is conducted in such patients.
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Ninomiya et al. (1994) conducted a case report in Complete atrioventricular block (n=1). Left heart catheterization was evaluated on Complete atrioventricular block. Left heart catheterization induced a rare, persistent complete atrioventricular block requiring a permanent pacemaker in a patient with pre-existing RBBB and left anterior hemiblock.
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