This case report cautions against relying solely on surface ECG to identify right ventricular pacing lead position due to potential inaccuracies.
Late QRS axis shift may indicate RV lead migration; leaves open ECG reliability for confirming true septal position.
Chronic right ventricular (RV) apical pacing may lead to the development of heart failure in some patients. Although pacing of the RV septum has been proposed as an alternative, positioning a lead in the true septum has proven challenging. In addition to fluoroscopy at implant, it has been suggested that 12-lead surface electrocardiogram (ECG) can be used to determine septal lead position; however, studies show this may be inaccurate. We present a case where a change in the ECG QRS axis late after pacemaker insertion with an active fixation lead highlights the difficulties of ECG localization of pacing leads.
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Kaye et al. (2017) studied this question.
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