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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

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Safe right bundle branch block pattern during permanent right ventricular pacing: a case report.

Abdelkarim Errahmouni¹, Jean Christophe Charniot, Jean Yves Artigou

¹Department of Cardiology, Avicenne Hospital, (Assistance Publique Des Hôpitaux De Paris), Bobigny, France. a.errahmouni@gmail.com.

Turk Kardiyoloji Dernegi Arsivi : Turk Kardiyoloji Derneginin Yayin Organidir

|October 10, 2013

Summary

A simple electrocardiogram (ECG) maneuver can help correctly interpret pacing patterns in patients with pacemakers. Lowering leads V1 and V2 resolved an unusual right bundle branch block (RBBB) pacing pattern, confirming correct lead placement.

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Area of Science:

Cardiology
Electrophysiology
Medical Diagnostics

Background:

Permanent transvenous DDD pacemaker implantation is a standard treatment for symptomatic complete heart block.
Postoperative electrocardiogram (ECG) interpretation is crucial for assessing pacemaker function and lead placement.
Unusual pacing patterns can indicate lead malposition, necessitating further investigation.

Observation:

A 72-year-old male presented with an atypical ECG pattern post-pacemaker implantation, showing a right bundle branch block (RBBB) with transition in V3 and left bundle branch block (LBBB) in D1.
Initial suspicion of left heart lead malposition was investigated.
Chest X-ray and echocardiogram confirmed correct apical right ventricular pacing, ruling out lead malposition.

Findings:

A novel ECG maneuver, involving repositioning leads V1 and V2 one intercostal space lower, was employed.
This maneuver successfully converted the atypical RBBB pacing pattern to the expected LBBB pattern.
This suggests the initial ECG findings were an artifact of lead placement relative to the chest wall, not lead malposition.

Implications:

This ECG maneuver offers a non-invasive method to differentiate true lead malposition from artifactual pacing patterns.
Accurate interpretation of pacemaker ECGs is vital for patient management and avoiding unnecessary interventions.
Further research into ECG maneuvers for pacemaker interpretation can improve diagnostic accuracy in electrophysiology.