Right bundle branch block pattern during right ventricular permanent pacing: Is it safe or not?

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Dual chamber pacemakers are common for cardiac rhythm management.
• Surface electrocardiogram (ECG) interpretation is crucial for pacemaker function assessment.
• A right bundle branch block (RBBB) pattern during ventricular pacing can sometimes indicate lead misplacement.

Purpose of the Study:

• To report a case of apparent ventricular lead malposition suggested by ECG findings.
• To differentiate between true lead malposition and a safe RBBB pattern during permanent pacing.
• To review diagnostic maneuvers for assessing ventricular lead placement in pacemaker patients.

Main Methods:

• Case report of a patient with a dual chamber pacemaker.
• Surface ECG analysis to identify paced RBBB pattern.
• Diagnostic work-up including imaging or intracardiac electrograms to confirm lead position.
• Review of literature on pacemaker lead placement and ECG interpretation.

Main Results:

• Surface ECG suggested left ventricular lead placement due to RBBB pattern.
• Diagnostic work-up confirmed the ventricular lead was appropriately located in the right ventricular apex.
• The RBBB pattern was determined to be a safe variant in this specific pacing context.

Conclusions:

• ECG findings suggestive of lead malposition require careful diagnostic evaluation.
• A paced RBBB pattern does not always indicate ventricular lead malposition.
• Understanding diagnostic clues is essential for safe permanent pacemaker implantation and follow-up.