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Seven years of left ventricular pacing due to malposition of pacing electrode
H Shmuely1, S Erdman, B Strasberg
1Department of Internal Medicine C, Beilinson Medical Center, Petah Tikva, Israel.
Insights
Left ventricular pacing can lead to right bundle branch block (RBBB) due to electrode malposition. This case report highlights a patient successfully managed with antiplatelet therapy, demonstrating a safe long-term outcome.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Transvenous cardiac pacing is a common procedure.
- Left ventricular pacing is an alternative pacing site.
- Right bundle branch block (RBBB) can be a complication of cardiac procedures.
Observation:
- A patient developed RBBB after uncomplicated left ventricular transvenous pacing.
- Echocardiography and cardiovascular computed tomography confirmed left ventricular pacing due to electrode malposition.
- No right ventricular rupture was observed.
Findings:
- The malpositioned pacing electrode in the left ventricle caused RBBB.
- The patient received aspirin and dipyridamole for treatment.
- No complications occurred during a 6-year follow-up period.
Implications:
- This case highlights the importance of imaging for diagnosing pacing lead complications.
- Long-term management with antiplatelet therapy can be effective for such cases.
- Understanding potential complications of left ventricular pacing is crucial for clinical practice.
Abstract:
The case report is presented of a patient in whom an uncomplicated left ventricular transvenous pacing produced right bundle branch block (RBBB). A diagnostic echocardiography, confirmed by cine cardiovascular computed tomography, showed that there was no rupture of the right ventricle and diagnosed a left ventricular pacing, due to malposition of the pacing electrode. The patient was treated with aspirin and dipyridamole during the last 6 years of follow-up, without any complications, including 1 year of pacing, prior to admission.