Right bundle branch blocks complete

Preexisting second- or third-degree AV block, right bundle branch block when associated with a left hemiblock (bifascicular block), unless a pacemaker is present to sustain the cardiac rhythm if complete heart block occurs recent myocardial infarction (Ml) presence of cardiogenic shock hypersensitivity to the drug. 

Septal ablation related mortality at experienced centers is currently 1% to 2%, similar to that of surgical myectomy (Table 4). Conduction system abnormalities are relatively common complications of septal ablation, Permanent right bundle branch block occurs in about 50% of patients and transitory complete heart block in 60% and permanent pacemakers required for high grade atrioventricular block in about 5% to 20%, Concerns of late occurrence of complete heart block following septal ablation mandates in-patient monitoring for 4 to 5 days,... 

In a 37-year-old woman with atrial flutter with 1 1 conduction and partial right bundle branch block, intravenous dofetihde 5 micrograms/kg given over 5 minutes not only suppressed the atrioventricular nodal block to 2 1 or 3 1 but also caused complete right bundle branch block and QT interval prolongation (58). 

Complete atrioventricular block occurred in a 10-year-old child with a history of hypertension, severe renal dysfunction, incomplete right bundle branch block, and a ventricular septal defect that had been repaired at birth (10). After slow induction with sevoflurane and nitrous oxide 66%, complete atrioventricular block occurred when the inspired sevoflurane concentration was 3% and reverted to sinus rhythm after withdrawal of the sevoflurane. The dysrhjrthmia recurred at the end of the procedure, possibly caused by lidocaine, which had infiltrated into the abdominal wound, and again at 24 hours in association with congestive cardiac failure following absorption of peritoneal dialysis fluid. 

Figure 4.54 (A) Preoperative ECG of a 58-year-old patient without heart disease. (B) In a postoperative period the patient suffered from massive pulmonary embolism with the ECG showing an AQRS pointing sharply to the right, complete right bundle branch block with the ST-segment elevation in some leads and sinus tachycardia. The P wave is visible in the majority of leads with occasional premature beats. (C) Patient died within minutes the ECG in agonic rhythm.

Figure 5.46 (A) Patient with complete right bundle branch block in acute phase of inferolateral infarction.

Exercise tolerance (stress) testing (ETT) is recommended for patients with intermediate pretest probability of CAD based on age, gender, and symptoms, including those with complete right bundle branch block or less than 1 mm of rest ST-segment depression (Fig. 15-3). Although ETT is insensitive for predicting coronary artery anatomy, it does correlate well with outcome, such as the likelihood of... 

Thomson IR, Dalton BC, Lappas DG, Lowenstein E. Right bundle-branch block and complete heart block caused by the Swan-Ganz catheter. Anesthesiology 1979 51 359-362. 

Sprung CL, Elser B, Schein RM, et al. Risk of right-bundle branch block and complete heart block during pulmonary artery catheterization. Crit Care Med 1989 17 1-3. 

A 56-year-old man presented in cardiac arrest and asystole after ingesting 7 g of lacosamide in a suicide attempt. After resuscitation, the patient had a jxmctional rhythm with widened QRS and hemi-left anterior bxmdle and complete right bundle branch block [73 ]. This patient ultimately died. It is important to be aware that lacosamide toxicity may cause widened QRS and can lead to death. Treatment should include sodium bicarbonate. 

After venous access, some consideration should be given to the sequence of lead placement. Some operators prefer to place the RV electrode first for emergency RV pacing, should heart block ensue because the heart failure patients commonly have a left bundle branch block and any trauma to the conduction system or right bundle may result in complete heart block. Other operators choose to place the coronary sinus lead first and, if necessary, depend on heart rate support via a temporary transvenous pacemaker placed via the femoral vein. The issue of failure speaks for placing the coronary sinus lead first. Should the procedure fail with unsuccessful left-sided left ventricular lead placement and the patient has already received right-sided electrodes, a pacing system may be left without an indication unless a future second attempt is considered. As more and more systems are placed for a primary prevention indication like MADIT II, this has become less problematic (153). 

In patients with left bundle branch block, it is advised that right ventricular lead placement be secured before left ventricular lead implantation or coronary sinus osteal localization since traumatic interruption of right bundle branch conduction could lead to the development of catheter-induced complete heart block and the need for urgent ventricular pacing. 

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