What is a potential complication of bi-fascicular block during Swan placement?

A bi-fascicular block involves a conduction disturbance within the heart, typically affecting two of the main fascicles in the bundle of His. During Swan-Ganz catheter placement, which is used for hemodynamic monitoring, manipulation of the heart's structure or rhythm can pose risks, particularly in patients with existing conduction abnormalities.

Complete heart block is a severe form of conduction disturbance where there is a failure of electrical impulses to be transmitted from the atria to the ventricles. In the context of a bi-fascicular block, this is a critical concern because the presence of two pathways being blocked increases the likelihood of a third degree, or complete, block occurring. During Swan-Ganz catheter placement, if there is any stress or change in myocardial demand or if the catheter inadvertently stimulates certain areas of the heart, it can precipitate the development of complete heart block.

Other complications like myocardial infarction, cardiac arrhythmia, and cardiac arrest can occur in various contexts but are less directly tied to the specific risk associated with bi-fascicular block during this procedure. The innate vulnerability of a patient with bi-fascicular block to progressing to complete heart block makes this the most relevant and concerning complication to consider during Swan placement.