COMPLETE ATRIOVENTRICULAR-BLOCK DURING LEFT-HEART CATHETERIZATION

A 75-year-old male underwent cardiac catheterization for frequent vent ricular premature contractions and reduced left ventricular function. ECG on admission showed complete right bundle branch block (RBBB) and left anterior hemiblock. Right heart catheterization was performed une ventfully, but complete atrioventricular block (CAVB) occurred suddenl y when a pig-tail catheter was inserted into the left ventricle. Elect rophysiological study identified this CAVB as HV block, and demonstrat ed HV prolongation in sinus rhythm. The coronary angiogram revealed no obstructive lesion or spasm with ergonovine. The reproducibility of t he CAVB was demonstrated. The final CAVB developed and persisted for m ore than one week, requiring the implantation of a permanent pacemaker (DDD). Complete atrioventricular block induced during left heart cath eterization is very rare. Pre-existing RBBB with left anterior or post erior hemiblock and reduced left ventricular function may be common fa ctors in patients with this condition. Emergency pacing equipment shou ld always be on-line when left heart catheterization is conducted in s uch patients.