Right Ventricular Septal Pacing: A Paradigm Shift

Figure 1:. RV anatomy and a summary of RV pacing sites. Figure reproduced from the Netter Collection of Medical Illustrations with permission from Elsevier, Inc.

Figure 2:. A: A 12-lead ECG with atrial and RV low septal pacing; QRS duration (QRSd): 150 ms. Note the Q wave in leads I and aVL. B: A posterioanterior view of the right atrial and septal RV leads on chest X-ray. C: A lateral view of the right atrial and septal RV leads. D: Schematic representation of the stylet shape showing the primary and secondary curves. E: Foreshortened view of the stylet shape demonstrating the secondary curve.

Figure 3:. A: A 12-lead ECG during RV apical pacing; QRSd: 160 ms. Note the positive R-waves in leads I and aVL and the QS complexes in the chest leads. B: A posteroanterior chest X-ray of the right atrial and RV apical leads. C: A lateral chest X-ray of the right atrial and RV apical leads.

Figure 4:. A: A 12-lead ECG with atrial and selective His-bundle pacing; QRSd: 90 ms. Note the normal-appearing QRS complexes with no T-wave changes. B: A posteroanterior chest X-ray of the right atrial and His-bundle pacing leads. C: A lateral chest X-ray of the right atrial and His-bundle pacing leads. HBP: His-bundle pacing.