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Related Experiment Videos

Safe right bundle branch block pattern during permanent right ventricular pacing.

Yung-Nien Yang1, Wei-Hsian Yin, Mason Shing Young

  • 1Division of Cardiology, Department of Internal Medicine, Armed Forces Sung-Shan Hospital, Taipei, Taiwan, R.O.C.

Journal of Electrocardiology
|February 28, 2003
PubMed
Summary

Right bundle branch block (RBBB) pacing morphology on an electrocardiogram (ECG) typically indicates pacemaker lead issues. However, this case shows RBBB can be a safe finding in transvenous right ventricular (RV) pacing, even with VDD pacemaker implantation.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Transvenous right ventricular (RV) pacing typically results in a left bundle branch block (LBBB) QRS pattern on electrocardiograms (ECGs).
  • The presence of a right bundle branch block (RBBB) pacing morphology in patients with RV pacemakers often raises concerns for lead malposition or myocardial perforation, even if asymptomatic.

Observation:

  • A 77-year-old male patient received a permanent VDD pacemaker for symptomatic heart block.
  • Postoperative ECG demonstrated a RBBB pacing configuration.
  • Chest X-ray and echocardiography confirmed uncomplicated RV pacing placement.

Findings:

  • The study presents a case where RBBB pacing morphology was observed despite successful and uncomplicated RV lead placement.

Related Experiment Videos

  • This challenges the typical expectation of LBBB morphology in RV pacing.
  • It underscores the need for a nuanced interpretation of pacing ECGs.

    • Implications:

    • This finding suggests that RBBB pacing morphology can be a safe, albeit unusual, finding after RV pacemaker implantation.
    • It emphasizes the importance of integrating imaging studies (X-ray, echocardiography) with ECG interpretation for accurate diagnosis.
    • Further research into the mechanisms and prevalence of safe RBBB pacing patterns is warranted.