Perioperative risk of bradyarrhythmias in patients with asymptomatic chronic bifascicular block or left bundle branch block: does an additional first-degree atrioventricular block make any difference?
In patients with chronic bifascicular block or LBBB, perioperative progression to complete heart block is rare. However, the rate of bradyarrhythmias with hemodynamic compromise proved to be relevant. Because an additional first-degree A-V block did not increase the incidence of severe bradyarrhythmias and pharmacotherapy by itself was successful in nearly all cases, routine prophylactic insertion of a temporary pacemaker in such patients should be questioned.
Proximally coated humeral stems for TSA showed few radiolucencies and no loosening at short- to midterm followup, reflecting an improvement over previous series. We now use these stems for primary TSAs and reserve cemented stems only when uncemented fixation is not possible owing to bony deficiency.