Inadvertent catheter-induced right bundle branch block in a patient with preexistent left bundle branch block and recurrent macroreentrant ventricular tachycardia.

Pacing and Clinical Electrophysiology : PACE
H D GössingerH Mösslacher

Abstract

This article describes the inadvertent, catheter-induced induction of right bundle branch block resulting not only in transient complete infra-His heart block but also in temporary interruption of the macroreentry circuit of ventricular tachycardia. A patient with preexistent left bundle branch block and spontaneous ventricular tachycardia based upon the bundle branch reentry mechanism underwent electrophysiological testing for the evaluation of sotalol drug efficacy. In search of an optimal His-bundle recording, the manipulation of a 6 Fr quadripolar catheter caused a right bundle branch block, thus advancing the preexistent left bundle branch block to complete heart block. Retrograde ventriculoatrial conduction remained unaffected. The macroreentrant tachycardia with left bundle branch block configuration was no longer inducible. While the patient continued on unchanged sotalol medication (320 mg/d) he required temporary pacing for 16 hours until the block subsided. A subsequent induction attempt demonstrated initiation of the tachycardia. Finally, guided by invasive testing, the patient successfully received amiodarone therapy (300 mg/d). The patient completed an uneventful follow up of 27 months. No progression of conductio...Continue Reading

References

Jun 1, 1986·Journal of the American College of Cardiology·P TouboulM P Mathieu
Feb 1, 1972·Chest·P K Gupta, J I Haft
Sep 1, 1983·Pacing and Clinical Electrophysiology : PACE·M AkhtarR Mahmud
Jul 1, 1982·American Heart Journal·W J WelchK M Rosen
Nov 1, 1982·American Heart Journal·E A LloydE N Prystowsky

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