CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by DOMINO, K. B.
Right arrow Articles by KLINEBERG, P. L.
Right arrow Search for Related Content
PubMed
Right arrow Articles by DOMINO, K. B.
Right arrow Articles by KLINEBERG, P. L.

Canadian Journal of Anesthesia, Vol 31, 302-306, Copyright © 1984 by Canadian Anesthesiologists' Society

Clinical Reports: Intraoperative Diagnosis of Rate- Dependent Bundle Branch Block

KAREN B. DOMINO MD1, KENNETH L. LAMANTIA MD1, RALPH T. GEER MD1, and PETER L. KLINEBERG MD1

1 Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104

Address correspondence to: Karen B. Domino, M.D., Department of Anesthesiology, Presbyterian-University Hospital, University of Pittsburgh, DeSoto at O'Hara Streets, Pittsburgh, Pennsylvania 15213.

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






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1984 by the Canadian Anesthesiologists' Society.