title: Perioperative transcutaneous pacemaker in patients with chronic bifascicular block or left bundle branch block and additional first-degree atrioventricular block.
abstract: BACKGROUND
  Complete heart block is dreaded perioperatively in patients with chronic bifascicular or left bundle branch block (LBBB) and additional first-degree A-V block. Our aim was to investigate the necessity as well as the efficacy and safety of transcutaneous pacing in the perioperative setting.
  
  
  METHODS
  Thirty-nine consecutive patients with asymptomatic chronic bifascicular block or LBBB and prolongation of the P-R interval scheduled to undergo surgery under anesthesia were prospectively enrolled in the study. Preoperatively, a transcutaneous pacemaker (PACE 500 D, Osypka Co.) was applied; its efficacy was checked with intra-arterial blood pressure measurement; the pain level was recorded. Additionally, 24-h Holter monitoring (CM2, CM5) was applied. Occurrences of a block progression or a bradycardia of <40 beats/min with hemodynamic impairment were the defined end points.
  
  
  RESULTS
  Thirty-seven of the 39 patients (95%) could be successfully stimulated with a median current strength of 70 mA; whereby 33 of the 39 patients felt moderate to severe pain. There was no perioperative block progression. Three cases of brady-cardia of <40 beats/min with a critical drop in blood pressure occurred; but these patients were successfully treated with drug therapy without pacemaker stimulation.
  
  
  CONCLUSIONS
  The perioperative application and testing of the pacemaker was safe and could be performed in nearly all patients successfully. However, we do not consider a routine prophylactic transcutaneous placement in patients with chronic bifascicular or LBBB and additional first-degree A-V block justified. Nevertheless, appropriate drugs and temporary pacemaker equipment should be easily accessible.
authors.affiliation: Department of Anesthesiology, University of Ulm, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Gauss
authors.forename: C
authors.initials: C
authors.lastname: Hübner
authors.forename: R
authors.initials: R
authors.lastname: Meierhenrich
authors.forename: H J
authors.initials: HJ
authors.lastname: Röhm
authors.forename: M
authors.initials: M
authors.lastname: Georgieff
authors.forename: W
authors.initials: W
authors.lastname: Schütz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D015924:Blood Pressure Monitors; D001919:Bradycardia / Q000209:etiology; D002037:Bundle-Branch Block / Q000150:complications / Q000628:therapy*; D002908:Chronic Disease; D018450:Disease Progression; D015716:Electrocardiography, Ambulatory; D005260:Female; D006327:Heart Block / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D010138:Pacemaker, Artificial / Q000009:adverse effects; D010146:Pain / Q000209:etiology; D019990:Perioperative Care; D011446:Prospective Studies; D012449:Safety; D013514:Surgical Procedures, Operative; D013520:Urologic Surgical Procedures