Document Detail

Perioperative transcutaneous pacemaker in patients with chronic bifascicular block or left bundle branch block and additional first-degree atrioventricular block.
MedLine Citation:
PMID:  10456813     Owner:  NLM     Status:  MEDLINE    
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.
A Gauss; C Hübner; R Meierhenrich; H J Röhm; M Georgieff; W Schütz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  43     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  1999 Aug 
Date Detail:
Created Date:  1999-09-30     Completed Date:  1999-09-30     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  731-6     Citation Subset:  IM    
Department of Anesthesiology, University of Ulm, Germany.
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MeSH Terms
Aged, 80 and over
Blood Pressure / physiology
Blood Pressure Monitors
Bradycardia / etiology
Bundle-Branch Block / complications,  therapy*
Chronic Disease
Disease Progression
Electrocardiography, Ambulatory
Heart Block / complications,  therapy*
Middle Aged
Ophthalmologic Surgical Procedures
Pacemaker, Artificial* / adverse effects
Pain / etiology
Perioperative Care*
Prospective Studies
Surgical Procedures, Operative*
Urologic Surgical Procedures

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