What is the clinical evidence from this study?

Study design: Case Report. Population: Complete left bundle branch block (CLBBB) (n=1). Intervention: Pulmonary artery catheter (PAC) insertion.

What question did this study set out to answer?

This report aims to highlight the occurrence of prolonged complete atrioventricular block during pulmonary artery catheter insertion in patients with left bundle branch block.

April 1, 2026Open Access

Prolonged complete atrioventricular block induced by insertion of a pulmonary arterial catheter in a patient with complete left bundle block: a case report

AKAtsuhiro KitauraCity University of New York HYHaruyuki YuasaKindai University TMTakashi MinoKindai University

Key Result

Insertion of a pulmonary artery catheter in a patient with complete left bundle branch block induced a prolonged complete atrioventricular block requiring temporary cardiac pacing.

Key Points

This report aims to highlight the occurrence of prolonged complete atrioventricular block during pulmonary artery catheter insertion in patients with left bundle branch block.
Described a case of prolonged complete AV block during PAC insertion
Administered 0.05 mg of adrenaline intravenously after 10 seconds of no escape beats
Introduced temporary cardiac pacing
Monitored sinus rhythm restoration after cardiopulmonary bypass
Prolonged complete AV block noted during PAC insertion
Escape beats did not appear for over 10 seconds
Adrenaline administration and pacing were required to restore sinus rhythm

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

1 77-year-old woman with complete left bundle branch block (CLBBB) and hypertension, scheduled for total arch replacement under general anesthesia.

Intervention

Insertion of a pulmonary artery catheter (PAC) via the right internal jugular vein.

Outcome

Prolonged complete atrioventricular (AV) blocksafety

Insertion of a pulmonary artery catheter in patients with complete left bundle branch block can induce life-threatening, prolonged complete atrioventricular block, highlighting the need for prophylactic transcutaneous pacing pads.

Limitations

Adrenaline dosage used (0.05 mg) was lower than the standard cardiac arrest dose (1 mg)
Continuous isoproterenol infusion was not utilized when transcutaneous pacing failed
PAC was inserted without X-ray imaging or transesophageal echocardiography guidance

Abstract

Prolonged complete atrioventricular (AV) block occurred during insertion of a pulmonary artery catheter (PAC) in a patient with complete left bundle branch block (CLBBB). As escape beats did not appear for more than 10 seconds, we administered 0.05 mg of adrenaline intravenously. QRS waves soon appeared, but complete AV block persisted. Temporary cardiac pacing was introduced and necessary even after cardiopulmonary bypass until sinus rhythm was restored. The risk of complete AV block in patients with CLBBB should be considered when a PAC is inserted because the right bundle branch is located on the surface of the right ventricle.

Demander à l'IA

Bookmark

View Full Paper