Key result
LBBP produces a rare RBBB pattern upon initial septal contact following pediatric VSD repair.
Case Report (n=1)
No
Superficial contact of a pacing lead with the right ventricular septal myocardium during attempted left bundle branch pacing can yield an unusual RBBB pattern on ECG in a child post-VSD repair.
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Superficial RV septal contact may produce RBBB ECG pattern during attempted LBBP; leaves open optimal positioning criteria in post-VSD repair patients.
After repair of a ventricular septal defect (VSD), atrioventricular conduction block frequently occurs, often requiring pacemaker implantation. Left bundle branch pacing (LBBP) is a physiological pacing modality and has become the preferred pacing approach in pacemaker-dependent children. Conventional right ventricular septal pacing typically produces a left bundle branch block (LBBB) pattern on the electrocardiogram (ECG). Herein, we report the case of a 3-year-old child who developed third-degree atrioventricular block complicated by right bundle branch block (RBBB) after VSD repair. The child subsequently received LBBP. During the procedure, the pacing lead only made superficial contact with the right ventricular septal myocardium without deep septal fixation, yielding an RBBB pattern on ECG. No relevant similar cases have been identified in the current literature, rendering this phenomenon rare in clinical practice.
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Bao et al. (2026) conducted a case report in Third-degree atrioventricular block following ventricular septal defect repair (n=1). Left bundle branch pacing was evaluated on Pacing morphology and parameters. Left bundle branch pacing in a child with third-degree atrioventricular block following ventricular septal defect repair produced a rare right bundle branch block pattern upon initial septal contact.
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