• Hyun-Cheol Ko, Yong-Hyun Cho, Won Jang, Sun-Hee Kim, Hyun-Seok Lee, and Woo-Hyeong Ko.
• Department of Anesthesiology and Pain Medicine, Seoul Sacred Heart General Hospital, Seoul, South Korea.
• Medicine (Baltimore). 2021 Mar 19; 100 (11): e25190e25190.

RationaleThe prone position is commonly used in spinal surgery. There have been many studies on hemodynamic changes in the prone position during general anesthesia. We report a rare case of transient left bundle branch block (LBBB) in a prone position.Patient ConcernElectrocardiogram (ECG) of a 64-year-old man scheduled for spinal surgery showed normal sinus rhythm change to LBBB after posture change to the prone position.DiagnosisTwelve lead ECG revealed LBBB. His coronary angio-computed tomography results showed right coronary artery with 30% to 40% stenosis and left circumflex artery with 40% to 50% stenosis. The patient was diagnosed with stable angina and second-degree atrioventricular block of Mobitz type II.InterventionNitroglycerin was administered intravenously during surgery. Adequate oxygen was supplied to the patient. After surgery, the patient was prescribed clopidogrel, statins, angiotensin II receptor blocker, and a permanent pacemaker was inserted.OutcomeSurgery was completed without complications. After surgery, the transient LBBB changed to a normal sinus rhythm. The patient did not complain of chest pain or dyspnea.LessonThe prone position causes significant hemodynamic changes. A high risk of cardiovascular disease may cause ischemic heart disease and ECG changes. Therefore, careful management is necessary.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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