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

Publisher Website
Google Scholar
Abstract
During insertion of Swan-Ganz catheters, mechanical right bundle branch block occurred in association with left posterior fascicular block in 2 patients and with left anterior fascicular block in two. None of the 4 patients had acute myocardial infarction or acute (spontaneous or iatrogenic) pulmonary disease. In 2 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. 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 1 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.