Canadian Anaesthetists’ Society Journal

, Volume 31, Issue 3, pp 302–306

Intraoperative diagnosis of rate-dependent bundle branch block

  • Karen B. Domino
  • Kenneth L. LaMantia
  • Ralph T. Geer
  • Peter L. Klineberg
Clinical Reports

Abstract

Rate-dependent left bundle branch block (LBBB) occasionally occurs during anaesthesia when the heart rate exceeds a critical value. While it is usually a benign disorder, it may mask the electrocardiographic manifestations of myocardial ischaemia and the ST-T wave pattern associated with LBBB may be mistaken for those of ischaemia, This case report presents two cases in which rate-dependent LBBB was clearly documented during the perioperative period. It demonstrates the use of pharmacologic agents (e.g., atropine and neostigmine) and physiologic manipulations (e.g., carotid sinus massage) to alter the heart rate and confirm the diagnosis of benign rate-dependent LBBB in the operating room. These interventions should be used with caution in patients who have hypertension, angina, cerebrovascular, or AV node disease or in the setting of myocardial ischaemia or severe bundle branch disease.

Key words

complications: arrhythmia heart: arrhythmia diagnosis treatment 

Résumé

Le bloc de branche gauche (LBBB) dépendant de la fréquence survient occasionnelfement durant l’anesthésie lorsque la fréquence dépasse un certain send critique. Cette anomalie est habituellement bénigne mais elk peut masquer les manifestations électrocardiographiques d’ischémie myocardique el la forme du tracé ST-T associée à ce bloc de branche peut être interprétée à tort comme indiquant un épisode ischemique. Cette observation présente deux cas où ce bloc de branche lié à la fréquence est clairement démontré durant la période péri-opératoire. On y démontre l’utilité de certains agents pharmacologiques (atropine et néostigmine) el de certaines manoeuvres physiologiques (massage du sinus carotidien) pour modifier la fréquence cardiaque et confirmer le diagnostic de cette anomalie. Ces diverses manipulations doivent s’employer avec prudence chez les patients qui présentent de l’hypertension, de l’angine, de l’insuffisance cérébrovasculaire de même que chez les malades présentant des anomalies du noœud auriculoventriculaire, de l’ischémie myocardique ou des troubles de conduction marques dans le faisceaux droit et gauche.

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Copyright information

© Canadian Anesthesiologists 1984

Authors and Affiliations

  • Karen B. Domino
    • 1
    • 2
  • Kenneth L. LaMantia
    • 1
  • Ralph T. Geer
    • 1
  • Peter L. Klineberg
    • 1
  1. 1.Department of AnesthesiaUniversity of PennsylvaniaPhiladelphia
  2. 2.Department of AnesthesiologyPresbyterian-University Hospital, University of PittsburghPittsburgh

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