Intermittent left bundle branch block following induction of general anesthesia in a healthy patient: a case report
Alrefaey Kandeel Alrefaey, Mohamed Hamed Mohamed
Abstract
The occurrence of a new-onset left bundle branch block under anesthesia is a challenging event. Intermittent left bundle branch block is uncommonly encountered inside the operating room. However, proper recognition of the nature and pathogenesis of intermittent left bundle branch block can prevent undue cancellation of surgery without endangering patient safety. In this report, a 69-year-old previously healthy patient, scheduled for total knee replacement under general anesthesia, developed intermittent left bundle branch block shortly after induction of anesthesia. After a multidisciplinary assessment, the planned surgery was resumed and completed safely. The patient was successfully extubated and transferred to the recovery room. Our patient was strongly advised to proceed with a formal cardiac evaluation to exclude any cardiac pathology, especially coronary artery disease. In addition to this specific case, this report explores the clinical implications of intraoperative intermittent left bundle branch block and its perioperative management plans
Keywords
References
Bazoukis G, Tsimos K, Korantzopoulos P. Episodic left bundle branch block: a comprehensive review of the literature. Ann Noninvasive Electrocardiol. 2016;21(2):117-25. http://doi.org/10.1111/anec.12361. PMid:27296905
Nasa P, Juneja D, Jain R, Golchha S. Transient bundle branch block during the perioperative period: a meta-summary of case reports. Indian J Anaesth. 2023;67(12):1123-5. http://doi.org/10.4103/ija.ija_476_23. PMid:38343669.
Tyagi A, Sethi AK, Agarwal V, Mohta M. Rate-dependent left bundle branch block during anaesthesia. Anaesth Intensive Care. 2004;32(5):715-8. http://doi.org/10.1177/0310057X0403200521. PMid:15535502.
Koo B-S, Lee M-S, Cho S-H, Kim S-H. Intraoperative detection of rate-dependent left bundle branch block. Soonchunhyang Med Sci. 2014;20(1):24-6. http://doi.org/10.15746/sms.14.005.
Laney J, Tran T, Motamed A. Critical heart rate and left bundle-branch block resolution in anesthesia. J Anaesthesiol Clin Pharmacol. 2020;36(2):282-5. http://doi.org/10.4103/joacp.JOACP_197_18. PMid:33013057.
Shiga T, Suzuki T, Somei M, Okumura N. Transient remission of pre-existing left bundle branch block during general anesthesia in a centenarian. JA Clin Rep. 2019;5(1):66. http://doi.org/10.1186/s40981-019-0288-0. PMid:32026081.
da Silva AMOC, da Silva EAGL. Intermittent left bundle branch block : reversal to normal conduction during general anesthesia. Rev Bras Anestesiol. 2017;67(4):430-4. http://doi.org/10.1016/j.bjane.2016.11.002. PMid:28012774.
Pillai A, Ellenbogen KA, Padala SK. A Tale of 2 Blocks. Circulation. 2021;143(100):1062-5. http://doi.org/10.1161/CIRCULATIONAHA.120.052981. PMid:33683947.
Raymond A, Ellenbogen A, Padala K. Multifaceted left bundle branch block: what are the mechanisms? JACC Case Rep. 2022;4(5):306-9. http://doi.org/10.1016/j.jaccas.2022.01.010. PMid:35257108.
Shenasa M, Josephson ME, Wit AL. Paroxysmal atrioventricular block: electrophysiological mechanism of phase 4 conduction block in the His-Purkinje system: a comparison with phase 3 block. Pacing Clin Electrophysiol. 2017;40(11):1234-41. http://doi.org/10.1111/pace.13187. PMid:28846146.
Reyford H, De Groote P, Guermouche T, Boufflers E, Menu H, Adnet P. Intermittent left bundle branch block revealed during anaesthesia. Br J Anaesth. 1994;72(6):700-1. http://doi.org/10.1093/bja/72.6.700. PMid:8024921.
Kumaravadivel DT, Nor Azian AZ, Thiruselvi S, Abdul Aziz J. Left bundle branch block under general anaesthesia in an athlete’s heart. Med J Malaysia. 2013;68(2):177-8. PMid:23629572.
Sivakumar S, Young MJ, Popilevsky L. New-onset intermittent deceleration-dependent left bundle branch block following induction of general anesthesia in a healthy patient: a case report. Cureus. 2024;16(2):e55211. http://doi.org/10.7759/cureus.55211. PMid:38425331.
Thompson A, Fleischmann KE, Smilowitz NR, de las Fuentes L, Mukherjee D, Aggarwal NR, et al. Guideline for perioperative cardiovascular management for noncardiac surgery: a report of the American College of Cardiology/ American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;150(19):e351-e442. http://doi.org/10.1161/CIR.0000000000001285. PMID:39316661.
Submitted date:
05/29/2025
Accepted date:
06/30/2025