Buss J, Neuss H, Bilgin Y, Gottwik M, Schlepper M
Z Kardiol. 1984 Nov;73(11):679-85.
During the course of 2,434 right heart catheterizations with 2,019 floating 3F Grandjean catheters and 415 5F Swan-Ganz catheters we observed 7 patients (0.3%) with catheter-induced infranodal conduction impairment: right bundle branch block (RBBB) in 3 patients, left anterior fascicular block (LAFB) and subsequent RBBB in 1 patient, and complete heart block in 3 patients with pre-existing left bundle branch block (LBBB). There was no apparent difference regarding the incidence of blocks between the two types of catheters. Three patients (one with LAFB + RBBB and two with LBBB) underwent electrophysiologic studies. All three patients exhibited a prolongation of the HV-interval due to coexisting pathologic changes of the right bundle. LBBB patterns disappeared during distal His bundle pacing in two patients, indicating a proximal site of block and suggesting incomplete involvement of the right bundle. Additional mechanical trauma, probably in this region, produced the blocks. Thus, use of balloon tipped or flexible catheters does not provide complete protection against transient lesions of the conduction system.
在使用2019根漂浮式3F Grandjean导管和415根5F Swan-Ganz导管进行的2434次右心导管插入术中，我们观察到7例（0.3%）患者出现导管诱发的结下传导障碍：3例患者出现右束支传导阻滞（RBBB），1例患者出现左前分支阻滞（LAFB）并随后出现RBBB，3例原有左束支传导阻滞（LBBB）的患者出现完全性心脏传导阻滞。两种类型导管之间的阻滞发生率没有明显差异。3例患者（1例为LAFB + RBBB，2例为LBBB）接受了电生理检查。所有3例患者均因右束支并存的病理改变而出现HV间期延长。2例患者在希氏束远端起搏时LBBB图形消失，提示阻滞部位在近端，表明右束支未完全受累。可能在该区域的额外机械损伤导致了传导阻滞。因此，使用球囊尖端或可弯曲导管并不能完全防止传导系统的短暂性损伤。
