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Pacing in Left Bundle-Branch Block During Swan-Ganz Catheterization-Reply

Denise Morris, MD; Daniel Mulvihill, MD; Wilbur Y. W. Lew, MD
Arch Intern Med. 1988;148(4):984. doi:10.1001/archinte.1988.00380040221036.
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In Reply.  —Drs Lavie and Gersh have addressed several important issues regarding our study.1 They suggest that in patients with left bundle-branch block (LBBB), extensive symptomatic conduction disease or the use of rigid catheters pose additional risks for developing catheter-induced complete heart block. We did not have the data to support or refute this contention. It is noteworthy that, in our study, the incidence of catheter-induced complete heart block in patients with LBBB was extremely low, despite the fact that these patients were critically ill. The majority of patients in our study had acute myocardial infarction, congestive heart failure, and/or cardiogenic shock. It is not clear if the risk for catheter-induced complete heart block in patients with LBBB is greater with severe conduction disease than with cardiogenic shock and/or ongoing myocardial ischemia.We agree with Drs Lavie and Gersh that recent refinements in external transthoracic temporary cardiac pacing2


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