Complete heart block during ultrasound-guided central venous catheterization

Excerpt

A 65-year-old woman with dialytic chronic kidney disease was admitted to our unit for treatment of a sepsis of urinary focus. Her medical history included hypertension, type 2 diabetes mellitus and dyslipidemia. Her home medications were furosemide, amlodipine, atenolol, hydralazine, omeprazole, aspirin, losartan, simvastatin and NPH insulin. Electrocardiogram (ECG) at admission showed a sinus rhythm with left bundle branch block. A real-time ultrasound-guided central venous catheter cannulation was attempted through the right internal jugular vein with the patient connected to a monitor that recorded her ECG and blood oxygen saturation. Before performing the cannulation, her heart rate was averaging 70–80 beats per minute. During the process of guidewire insertion, her heart rate suddenly dropped to 35 beats per minute, and the ECG on the monitor displayed a pattern compatible with a complete heart block. A stat ECG was obtained (Fig. 1), which confirmed the complete heart block. She remained irresponsive for 30 s, but her blood pressure was unaltered. Application of external transcutaneous pacing was suggested, but in the meanwhile, over the next 20 min, the patient spontaneously regained her previous baseline rhythm. A panel of cardiac enzymes was performed, and came out normal. The rest of her clinical course included the treatment of infection-related complications, but no further dysrhythmic event was detected during the hospitalization, and an outpatient follow-up after 2 months revealed no further clinical events, and her ECG was similar to her previous baseline rhythm.

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