Left fascicular blocks during right-heart catheterization using the Swan-Ganz catheter

Agustin Castellanos, A. V. Ramirez, A. Mayorga-Cortes, K. Pefkaros, J. J. Rozanski, C. Sprung, Robert J Myerburg

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

During insertion of Swan-Ganz catheters, mechanical right bundle branch block occurred in association with left posterior fascicular block in two patients and with left anterior fascicular block in two. None of the four patients had acute myocardial infarction or acute (spontaneous or iatrogenic) pulmonary disease. In two cases, electrophysiologic studies demonstrated the coexistence of intra- and infra-Hisian conduction delays and blocks. Although the right bundle branch block may have resulted from injury to the central or peripheral right branch, the left fascicular blocks could not be explained by direct trauma to these left-sided structures. Our findings support the recent clinical and experimental reports that show that left fascicular block (as well as right bundle branch block) may be due to lesions involving the His bundle; presumably because of longitudinal dissociation of this structure affecting the transverse interconnections. In one patient, 2:1 intra-Hisian block may have coexisted with bradycardia-dependent (phase 4) right bundle branch block. More studies are required to determine the implications of catheter-induced conduction disturbances in other clinical settings, such as acute myocardial infarction.

Original languageEnglish
Pages (from-to)1271-1276
Number of pages6
JournalCirculation
Volume64
Issue number6
StatePublished - Dec 1 1981

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Bundle-Branch Block
Cardiac Catheterization
Catheters
Myocardial Infarction
Iatrogenic Disease
Bundle of His
Wounds and Injuries
Bradycardia
Lung Diseases

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Castellanos, A., Ramirez, A. V., Mayorga-Cortes, A., Pefkaros, K., Rozanski, J. J., Sprung, C., & Myerburg, R. J. (1981). Left fascicular blocks during right-heart catheterization using the Swan-Ganz catheter. Circulation, 64(6), 1271-1276.

Left fascicular blocks during right-heart catheterization using the Swan-Ganz catheter. / Castellanos, Agustin; Ramirez, A. V.; Mayorga-Cortes, A.; Pefkaros, K.; Rozanski, J. J.; Sprung, C.; Myerburg, Robert J.

In: Circulation, Vol. 64, No. 6, 01.12.1981, p. 1271-1276.

Research output: Contribution to journalArticle

Castellanos, A, Ramirez, AV, Mayorga-Cortes, A, Pefkaros, K, Rozanski, JJ, Sprung, C & Myerburg, RJ 1981, 'Left fascicular blocks during right-heart catheterization using the Swan-Ganz catheter', Circulation, vol. 64, no. 6, pp. 1271-1276.
Castellanos A, Ramirez AV, Mayorga-Cortes A, Pefkaros K, Rozanski JJ, Sprung C et al. Left fascicular blocks during right-heart catheterization using the Swan-Ganz catheter. Circulation. 1981 Dec 1;64(6):1271-1276.
Castellanos, Agustin ; Ramirez, A. V. ; Mayorga-Cortes, A. ; Pefkaros, K. ; Rozanski, J. J. ; Sprung, C. ; Myerburg, Robert J. / Left fascicular blocks during right-heart catheterization using the Swan-Ganz catheter. In: Circulation. 1981 ; Vol. 64, No. 6. pp. 1271-1276.
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AB - During insertion of Swan-Ganz catheters, mechanical right bundle branch block occurred in association with left posterior fascicular block in two patients and with left anterior fascicular block in two. None of the four patients had acute myocardial infarction or acute (spontaneous or iatrogenic) pulmonary disease. In two cases, electrophysiologic studies demonstrated the coexistence of intra- and infra-Hisian conduction delays and blocks. Although the right bundle branch block may have resulted from injury to the central or peripheral right branch, the left fascicular blocks could not be explained by direct trauma to these left-sided structures. Our findings support the recent clinical and experimental reports that show that left fascicular block (as well as right bundle branch block) may be due to lesions involving the His bundle; presumably because of longitudinal dissociation of this structure affecting the transverse interconnections. In one patient, 2:1 intra-Hisian block may have coexisted with bradycardia-dependent (phase 4) right bundle branch block. More studies are required to determine the implications of catheter-induced conduction disturbances in other clinical settings, such as acute myocardial infarction.

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