Complete heart block during central venous catheter placement in a patient with pre-existing left bundle branch block

Heart block and arrhythmia are complications of pulmonary arteryand cardiac catheterization. Injury to the conducting systemof the heart often involves the right bundle causing right bundlebranch block (RBBB). If patients already have left bundle branchblock (LBBB), complete heart block (CHB) may result. After trauma,impairment of the right bundle is usually transient with recoveryin hours, but complete heart block can lead to symptoms requiringinvasive treatment. Similar complications are rare with insertionof central venous catheters, as they should not enter the heart.Injury to the right bundle during central venous catheter insertioncan be by trauma from the guide wire or from the catheter itself.The function of the AV node and bundle of His in these patientshas not been studied before. We report a patient with LBBB whodeveloped CHB during insertion of a central venous cannula.Conduction through the AV node and His–Purkinje systemwas intact, showing that the transient RBBB was caused by traumaticinjury rather than by other disease of the conduction system. Br J Anaesth 2003; 91: 747–9