Risk of developing right bundle branch block [R. B. B. B.] and complete heart block [C. H. B.] during pulmonary artery catheterization in open heart surgery patients

ABSTRACT

To analyze the incidence and associated haemodynamic disturbances of a new Right Bundle Branch Block [R.B.B.B] induced by Pulmonary Artery Catheter [P.A.C] with a particular emphasis in patients with preexisting Left Bundle Branch Block [L.B.B.B.] in a prospective manner. To establish whether prophylactic placement of a ventricular pacemaker in patients with pre existing L.B.B.B. during pulmonary artery cotheterization is necessary. The study was conducted at the department of Anaesthesiology and intensive care of the Aga Khan University Hospital, Karachi. Pulmonary artery catheterization was performed in 125 adult patients who underwent various open heart surgical procedures. Outcome studied Incidence of new R.B.B.B induced by P.A.C. and its associated haemodynamic disturbances with a particular emphasis in patients with a pre existing L.B.B.B. was recorded. New R.B.B.B. occurred in 13 [10.4%] patients while none of the 1 1 patients with a preexisting R.B.B.B. developed C.H.B. during the procedure. Development of new block was not associated with any haemodynamic disturbance. Prophylactic temporary pacing is recommended in patients having a pre-existing R.B.B.B. before placement of P.A.C. in previous studies. However, our study does not show that previous R.B.B.B. is at risk of developing complete heart block [C.H.B.] during the procedure. In view of grave consequences of C.H.B. It is recommended that facilities of pacing should be on board in case it happens