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

A retrospective analysis of 217 consecutive patients with chronic bundle branch blocks undergoing cardiac catheterization was done to evaluate the need for temporary transvenous pacing during coronary arteriography. In patients without temporary right ventricular pacemakers (n = 185), only one episode of high-grade atrioventricular block occurred during coronary arteriography which required the urgent use of temporary pacing. All other bradyarrhythmias, including five episodes of transient asystole (greater than 3-sec pause) and four episodes of atrioventricular block (second degree or higher) were successfully managed without pacemaker utilization. Patients with prophylactic right ventricular pacemakers (n = 32) had a greater prevalence of ventricular fibrillation than those without pacing electrodes located in the right ventricle (2% vs. 9% respectively; P less than 0.05). These findings suggest that routing prophylactic pacemaker insertion during coronary arteriography in patients with chronic bundle branch block is not warranted and may place the patient at risk for developing iatrogenic ventricular arrhythmias.