Asymptomatic Permanent Left Bundle Branch Block (LBBB) complicating Diagnostic Left Heart Catheterisation

Abstract

This case report describes a routine diagnostic left heart catheterisation (coronary angiography, aortography and left ventriculography) procedure at Sultan Qaboos University Hospital, Oman, which was complicated by the development of new asymptomatic, but permanent, left bundle branch block that was observed incidentally towards the end of the procedure. The patient was completely asymptomatic and haemodynamically stable throughout the procedure and afterwards. Urgent investigations, immediately after the procedure, including routine blood, serial cardiac troponin I, serial electrocardiograms, chest X-ray, and urgent echocardiography were normal and failed to show any possible causation of the LBBB. The results of left heart catheterisation showed two vessel coronary artery disease and severe mitral valve regurgitation. After eight days, the patient went on to have coronary artery bypass surgery and mitral valve replacement surgery both of which were successful. To the best of our knowledge, this is the first case report to describe the occurrence of permanent LBBB after left heart catheterisation. This report describes the case and reviews the literature for the incidence and implications of such a complication.

Keywords: Case Report; Coronary angiography; Diagnostic heart catheterisation; LBBB; Left bundle branch block; Left heart catheterisation; Left ventriculography; Oman; aortography.

Figure 1

The initial ECG taken one day prior to the cardiac catheterisation procedure.

Figure 2

The ECG of the patient taken immediately after left heart catheterisation procedure. It shows a typical left bundle branch block pattern that was not present on the initial ECG [Figure 1].

Figure 3a

A standard J-shaped tip diagnostic guide wire that is commonly used during left heart catheterisation procedures.

Figure 3b

a standard 6 French “pigtail” diagnostic catheter.