title: Rate-Dependent Left Bundle Branch Block in an Ambulatory Surgery Patient: A Case Report.
abstract: A 52-year-old woman, ASA II (American Society of Anesthesia classification II) scheduled for cholecystectomy in an ambulatory center, exhibited a wide-complex tachycardia with ectopy on the monitor after induction with propofol and succinylcholine. Blood pressure remained stable; amiodarone was administered for presumed ventricular tachycardia. A 12-lead electrocardiogram (ECG) showed a new left bundle branch block (LBBB) at 98 beats per minute (bpm), which resolved when the heart rate slowed. Surgery was postponed, and both the LBBB and ectopy recurred frequently during the next 24 hours in the intensive care unit, particularly at heart rates >90 bpm. Troponins were normal, and the patient was diagnosed with a rate-dependent LBBB and cleared for surgery.
authors.affiliation: *Department of Anesthesiology, Texas Tech School of Medicine, Lubbock, Texas; and †Department of Surgery, Texas Tech School of Medicine and Swat Surgical Associates, Lubbock, Texas.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Farag
authors.forename: Justin
authors.initials: J
authors.lastname: Tsai
authors.forename: Sam
authors.initials: S
authors.lastname: Deeb
authors.forename: Deidre
authors.initials: D
authors.lastname: Putman-Garcia
authors.forename: John D
authors.initials: JD
authors.lastname: Wasnick
authors.forename: Lydia A
authors.initials: LA
authors.lastname: Conlay
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000639:trends*; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D004562:Electrocardiography / Q000639:trends; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008875:Middle Aged