| Perioperative transcutaneous pacemaker in patients with chronic bifascicular block or left bundle branch block and additional first-degree atrioventricular block. | |
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MedLine Citation:
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PMID: 10456813 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Complete heart block is dreaded perioperatively in patients with chronic bifascicular or left bundle branch block (LBBB) and additional first-degree A-V block. Our aim was to investigate the necessity as well as the efficacy and safety of transcutaneous pacing in the perioperative setting. METHODS: Thirty-nine consecutive patients with asymptomatic chronic bifascicular block or LBBB and prolongation of the P-R interval scheduled to undergo surgery under anesthesia were prospectively enrolled in the study. Preoperatively, a transcutaneous pacemaker (PACE 500 D, Osypka Co.) was applied; its efficacy was checked with intra-arterial blood pressure measurement; the pain level was recorded. Additionally, 24-h Holter monitoring (CM2, CM5) was applied. Occurrences of a block progression or a bradycardia of <40 beats/min with hemodynamic impairment were the defined end points. RESULTS: Thirty-seven of the 39 patients (95%) could be successfully stimulated with a median current strength of 70 mA; whereby 33 of the 39 patients felt moderate to severe pain. There was no perioperative block progression. Three cases of brady-cardia of <40 beats/min with a critical drop in blood pressure occurred; but these patients were successfully treated with drug therapy without pacemaker stimulation. CONCLUSION: The perioperative application and testing of the pacemaker was safe and could be performed in nearly all patients successfully. However, we do not consider a routine prophylactic transcutaneous placement in patients with chronic bifascicular or LBBB and additional first-degree A-V block justified. Nevertheless, appropriate drugs and temporary pacemaker equipment should be easily accessible. |
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Authors:
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A Gauss; C Hübner; R Meierhenrich; H J Röhm; M Georgieff; W Schütz |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Acta anaesthesiologica Scandinavica Volume: 43 ISSN: 0001-5172 ISO Abbreviation: Acta Anaesthesiol Scand Publication Date: 1999 Aug |
Date Detail:
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Created Date: 1999-09-30 Completed Date: 1999-09-30 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0370270 Medline TA: Acta Anaesthesiol Scand Country: DENMARK |
Other Details:
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Languages: eng Pagination: 731-6 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, University of Ulm, Germany. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Blood Pressure / physiology Blood Pressure Monitors Bradycardia / etiology Bundle-Branch Block / complications, therapy* Chronic Disease Disease Progression Electrocardiography, Ambulatory Female Heart Block / complications, therapy* Humans Male Middle Aged Ophthalmologic Surgical Procedures Pacemaker, Artificial* / adverse effects Pain / etiology Perioperative Care* Prospective Studies Safety Surgical Procedures, Operative* Urologic Surgical Procedures |
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