Arrhythmias during Intracardiac Catheterization

Michel, Jörg; Johnson, A. D.; Bridges, W. C.; Lehmann, J. H.; Gray, Frank D.; Field, Loren J.; Green, D. M.

doi:10.1161/01.cir.2.2.240

Cited by 36 publications

(4 citation statements)

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“…Conduction disturbances were recognized during the very early practice of intracardiac catheterization[ 27 ]. It was anticipated that advancing catheters through the ventricle, would irritate the right bundle branch and its fascicular branches and might lead to transient or even permanent injuries.…”

Section: Discussionmentioning

confidence: 99%

Intra-procedural arrhythmia during cardiac catheterization: A systematic review of literature

Shaik

Slotwiner

Gustafson

et al. 2020

WJC

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BACKGROUND Cardiac catheterization is among the most performed medical procedures in the modern era. There were sporadic reports indicating that cardiac arrhythmias are common during cardiac catheterization, and there are risks of developing serious and potentially life-threatening arrhythmias, such as sustained ventricular tachycardia (VT), ventricular fibrillation (VF) and high-grade conduction disturbances such as complete heart block (CHB), requiring immediate interventions. However, there is lack of systematic overview of these conditions. AIM To systematically review existing literature and gain better understanding of the incidence of cardiac arrhythmias during cardiac catheterization, and their impact on outcomes, as well as potential approaches to minimize this risk. METHODS We applied a combination of terms potentially used in reports describing various cardiac arrhythmias during common cardiac catheterization procedures to systematically search PubMed, EMBASE and Cochrane databases, as well as references of full-length articles. RESULTS During right heart catheterization (RHC), the incidence of atrial arrhythmias (premature atrial complexes, atrial fibrillation and flutter) was low (< 1%); these arrhythmias were usually transient and self-limited. RHC associated with the development of a new RBBB at a rate of 0.1%-0.3% in individuals with normal conduction system but up to 6.3% in individuals with pre-existing left bundle branch block. These patients may require temporary pacing due to transient CHB. Isolated premature ventricular complexes or non-sustained VT are common during RHC (up to 20% of cases). Sustained ventricular arrhythmias (VT and/or VF) requiring either withdrawal of catheter or cardioversion occurred infrequently (1%-1.3%). During left heart catheterizations (LHC), the incidence of ventricular arrhythmias has declined significantly over the last few decades, from 1.1% historically to 0.1% currently. The overall reported rate of VT/VF in diagnostic LHC and coronary angiography is 0.8%. The risk of VT/VF was higher during percutaneous coronary interventions for stable coronary artery disease (1.1%) and even higher for patients with acute myocardial infarctions (4.1%-4.3%). Intravenous adenosine and papaverine bolus for fractional flow reserve measurement, as well as intracoronary imaging using optical coherence tomography have been reported to induce VF. Although uncommon, LHC and coronary angiography were also reported to induce conduction disturbances including CHB. CONCLUSION Cardiac arrhythmias are common and potentially serious complications of cardiac catheterization procedures, and it demands constant vigilance and readiness to intervene during procedures.

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Section: Discussionmentioning

confidence: 99%

Intra-procedural arrhythmia during cardiac catheterization: A systematic review of literature

Shaik

Slotwiner

Gustafson

et al. 2020

WJC

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“…The impact of mechanical action on the heart work is confirmed by observations from the medical practice: cases of sudden death from a blow to the chest in the area of the heart or arrhythmias occurring during catheterization [10,11]. Mechanical sensitivity is being actively studied at various levels from a cell to the whole organ [12][13][14][15][16] and in different parts of the heart: atria and ventricles [17][18][19].…”

Section: Introductionmentioning

confidence: 98%

Application of Multielectrode Mapping to Assess the Effect of Mechanical Right Atrium Distension on the Work of the Isolated Rat Heart

Харьковская¹,

Куликова²,

Kataev³

et al. 2018

Sovrem Tehnol Med

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The aim of the study was to assess the effect of mechanical right atrium distension of the isolated rat heart on the heart rate and heart rate variability, and the velocity of excitation wave propagation in the left ventricular myocardium using multielectrode mapping with flexible arrays. Materials and Methods. Experimental studies have been performed on the isolated rat heart in compliance with the Langendorff technique. Electrical heart activity was recorded using a flexible multielectrode array system. Results. Characteristic electrophysiological parameter changes of the isolated heart with the right atrium distension were detected using multielectrode mapping with flexible arrays. The flexible array design allowed registration of electrical potentials from the left ventricular surface of the actively contracting rat heart perfused according to the Langendorff technique and assessment of interconnection in the work of different parts of the heart: the right atrium in which the sinus node regulating the heart rate is located and the left ventricle. Application of multiple electrodes arranged in a specific way in the array made it possible to analyze spatio-temporal characteristics of electrical activity on the heart surface and to establish both the increase of the sinus node excitation frequency and excitation wave propagation velocity in the left ventricle. Conclusion. The growth of heart rate variability may suggest the existence of additional mechano-induced processes generating electrical instability in the distended atrium. The effects detected in the left ventricle with the given method may be caused by triggering intracardial regulation mechanisms.

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“…As early as 1950, catheter‐induced arrhythmias during cardiac catheterization have been reported, mainly including premature beats and conduction abnormalities 1 . Due to its endocardial course, the right bundle branch (RBB) is prone to traumatic “bumping” effects during catheter manipulation adjacent to the distal His bundle (HB) and RBB region 1,2 . In the era of invasive cardiac electrophysiology, catheter‐induced RBB block (CI‐RBBB) is a common phenomenon observed during electrophysiological studies (EPS) 3 …”

Section: Introductionmentioning

confidence: 99%

“…1 Due to its endocardial course, the right bundle branch (RBB) is prone to traumatic "bumping" effects during catheter manipulation adjacent to the distal His bundle (HB) and RBB region. 1,2 In the era of invasive cardiac electrophysiology, catheter-induced RBB block (CI-RBBB) is a common phenomenon observed during electrophysiological studies (EPS). 3 It is typically transient but with a variable duration lasting from a few seconds to the entire EPS time (i.e., a few hours).…”

Section: Introductionmentioning

confidence: 99%

Catheter‐induced right bundle branch block: Practical implications for the cardiac electrophysiologist

Ali,

Lupo,

Foresti

et al. 2023

Cardiovasc electrophysiol

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The right bundle branch (RBB), due to its endocardial course, is susceptible to traumatic block caused by “bumping” during right‐heart catheterization. In the era of cardiac electrophysiology, catheter‐induced RBB block (CI‐RBBB) has become a common phenomenon observed during electrophysiological studies and catheter ablation procedures. While typically transient, it may persist for the entire procedure time. Compared to pre‐existing RBBB, the transient nature of CI‐RBBB allows for comparative analysis relative to the baseline rhythm. Furthermore, unlike functional RBBB, it occurs at similar heart rates, making the comparison of conduction intervals more reliable. While CI‐RBBB can provide valuable diagnostic information in various conditions, it is often overlooked by cardiac electrophysiologists. Though it is usually a benign and self‐limiting conduction defect, it may occasionally lead to diagnostic difficulties, pitfalls, or undesired consequences. Avoidance of CI‐RBBB is advised in the presence of baseline complete left bundle branch block and when approaching arrhythmic substrates linked to the right His‐Purkinje‐System, such as fasciculo‐ventricular pathways, bundle branch reentry, and right‐Purkinje focal ventricular arrhythmias. This article aims to provide a comprehensive practical review of the electrophysiological phenomena related to CI‐RBBB and its impact on the intrinsic conduction system and various arrhythmic substrates.

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Arrhythmias during Intracardiac Catheterization

Abstract: This paper summarizes the incidence of various arrhythmias in an unselected series of cardiac catheterizations and presents evidence for their reflex origin in some instances. The hazards are discussed and comments made about prophylaxis and treatment.

Cited by 36 publications

References 0 publications

Intra-procedural arrhythmia during cardiac catheterization: A systematic review of literature

Intra-procedural arrhythmia during cardiac catheterization: A systematic review of literature

Application of Multielectrode Mapping to Assess the Effect of Mechanical Right Atrium Distension on the Work of the Isolated Rat Heart

Catheter‐induced right bundle branch block: Practical implications for the cardiac electrophysiologist

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