Q: 45 year old male is admitted to ICU with probable cardiogenic shock. Decision was made to insert Pulmonary Artery Catheter (PAC). Patient EKG showed Left Bundle Branch Block (LBBB). Which one precaution should be taken?


Answer: About 5 percent of patients develop Right Bundle Branch Block (RBBB) on PAC insertion. Patients with already documented LBBB on EKG may develop complete heart block. In such patients, backup rescue plan should be made to counter such situation promptly by having  a transthoracic or transvenous pacer. Ideally, such patients should have PAC insertion with pacer port - and if clinical situation allow, under fluoroscopic guidance.



Reference: 

Sprung CL, Elser B, Schein RM, et al. Risk of right bundle-branch block and complete heart block during pulmonary artery catheterization. Crit Care Med 1989; 17:1.