Cardiac pacing in left bundle branch/ bifascicular block patients

Abstract

The primary concern in patients with bifascicular block is the increased risk of progression to complete heart block. Further, an additional first-degree A-V block in patients with bifascicular block or LBBB might increase the risk of block progression. Anesthesia, monitoring and surgical techniques can induce conduction defects and bradyarrhythmias in patients with pre-existing bundle branch block. In the setting of an acute MI, several different types of conduction disturbance may become manifest and complete heart block occurs usually in patients with acute myocardial infarction more commonly if there is pre-existing or new bundle branch block. The question that arises is whether it is necessary to insert a temporary pacing catheter in patients with bifascicular block undergoing anesthesia. It is important that an anesthesiologist should be aware of the indications for temporary cardiac pacing as well as the current recommendations for permanent pacing in patients with chronic bifascicular and trifascicular block. This article also highlights the recent guidelines for temporary transvenous pacing in the setting of acute MI and the different pacing modalities that are available for an anesthesiologist.

Bradyarrhythmias and Physiologic Pacing in the ICU

“…22 The presence of first-degree AV delay with bifascicular block, often incorrectly called trifascicular block (as the AV node is not a fascicle), may be associated with increased risk of progression to CHB and the risk of cardiac death. 23 The significance of pre-existing bifascicular block in the ICU setting may also be related to procedural risks. For example, in patients with pre-existing LBBB who undergo pulmonary arterial catheter placement, there is a risk of mechanical trauma to the RBBB resulting in transient CHB.…”

Chronic bifascicular block in a geriatric patient presenting for elective surgery. How prepared can we be?

“…The availability of external non-invasive pacing (transcutaneous and transoesophageal) may preclude the need for transvenous pacing, which itself might have adverse consequences in these elderly patients. [ 5 ] Transcutaneous pacing is one of the techniques of external non-invasive pacing and is an important alternative when emergency transvenous pacing is immediately not available. We had placed stick on paddles to enable cutaneous pacing had the patient progressed to CHB or severe bradycardia.…”