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Bradyarrhythmias are cardiac rhythm disorders characterized by a slower-than-normal heart rate, typically defined as fewer than 60 beats per minute. Some of which are discussed here:Sinus BradycardiaSinus bradycardia presents a heart rate lower than 60 beats per minute, with a regular rhythm originating from the SA node. The ECG typically shows normal P waves preceding each QRS complex, a normal PR interval (0.12 to 0.20 seconds), and a normal QRS duration (0.06 to 0.10 seconds).First-Degree AV...
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Arrhythmia or dysrhythmia refers to an abnormal heart rhythm caused by a defect in the heart's conduction system. It can cause the heart to beat irregularly, too quickly, or too slowly, leading to symptoms like chest pain, shortness of breath, and fainting. Factors such as stress, caffeine, alcohol, nicotine, cocaine, certain drugs, congenital defects, diseases, and electrolyte abnormalities can trigger arrhythmias.
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Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
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Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
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The Cardiac Cycle01:13

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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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[Right bundle branch block during right ventricular pacing].

Harilaos Bogossian1,2, Fuad Hasan3, Gerrit Frommeyer4

  • 1Department of Cardiology and Angiology, Klinikum Lüdenscheid Märkische Kliniken GmbH, Paulmannshöherstr. 14, 58515, Lüdenscheid, Deutschland. Harilaos.bogossian@klinikum-luedenscheid.de.

Herzschrittmachertherapie & Elektrophysiologie
|November 16, 2016
PubMed
Summary
This summary is machine-generated.

Incorrect ECG electrode placement can mimic right bundle branch block (RBBB) in wide complex tachycardia. Repositioning leads V1 and V2 resolved the apparent RBBB, confirming lead misplacement as the cause.

Keywords:
4th intercostal spacePrecordial leadsRight bundle branch block

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Area of Science:

  • Clinical Cardiology
  • Electrophysiology
  • Diagnostic Imaging

Background:

  • A 78-year-old patient presented for wide complex tachycardia ablation.
  • The initial electrocardiogram (ECG) showed right bundle branch block (RBBB) morphology.
  • A pacemaker spike indicated supraventricular tachycardia with AV synchronous ventricular pacing.

Observation:

  • Electrophysiological study diagnosed atrial tachycardia with 1:1 AV pacing.
  • ECG presented negative concordance in precordial leads.
  • Shifting precordial leads V1 and V2 to the 2nd intercostal space resolved the discrepancy.

Findings:

  • Apparent RBBB morphology was attributed to malpositioned ECG electrodes.
  • Misplaced electrodes alter lead characteristics from horizontal to frontal plane properties.
  • Precordial leads V1 and V2, when misplaced, can imitate aVL and aVR, mimicking RBBB.

Implications:

  • Accurate ECG electrode placement is crucial for correct tachycardia diagnosis.
  • This case highlights a potential pitfall in interpreting wide complex tachycardia.
  • Proper lead positioning ensures reliable ECG interpretation in patients with pacemakers.