Postoperative Episodic Left Bundle Branch Block

Elterman, Kelly G. MD; Mallampati, Seshagiri Rao MD; Tedrow, Usha B. MD, MS; Urman, Richard D. MD, MBA

doi: 10.1097/ACC.0b013e3182a963be
Case Reports: Case Report

Transient left bundle branch block (LBBB) associated with physical exertion has been described in patients with and without coronary artery disease. A 64-year-old woman with no history of coronary artery disease underwent Nissen fundoplication under general anesthesia. Preoperatively, an exercise-tolerance test revealed LBBB, without ischemic symptoms. Intraoperatively, the electrocardiogram revealed normal sinus rhythm. Postoperatively, LBBB appeared in the absence of clinical symptoms or physiologic stress. The patient reported several similar episodes previously. Cardiac enzymes were negative. Subsequent electrocardiograms revealed persistence of LBBB. Anesthesiologists should be aware of the possibility of perioperative transient LBBB in the absence of cardiac ischemia.

From the Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts.

Accepted for publication August 12, 2013

Funding: Not funded.

This report was previously presented, in part, at the American Society of Anesthesiologists.

The authors declare no conflicts of interest.

Address correspondence to Kelly G. Elterman, MD, Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, 75 Francis St., CWN-L1, Boston, MA 02115. Address e-mail to kelterman@partners.org.

© 2014 International Anesthesia Research Society