Why the study?
Does an RBBB pattern on ECG during right ventricular endocardial pacing indicate lead malposition in patients with pacemakers?
Does an RBBB pattern on ECG during right ventricular endocardial pacing indicate lead malposition in patients with pacemakers?
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An RBBB pattern observed during RV endocardial pacing in standard precordial leads usually represents safe pacing rather than lead perforation or malposition, and can resolve to an LBBB pattern when leads are recorded in the 5th intercostal space.
Right bundle branch block (RBBB) pattern recorded during right ventricular (RV) endocardial pacing should be given special attention in terms of safe RV pacing or lead malposition, e.g. left ventricular pacing or coronary venous pacing, even for patients with no symptoms. Paced electrocardiograms from 47 consecutive patients with a pacemaker implanted were studied. Four patients (8.5%) were found to have RBBB pattern recorded in precordial V 1 and V 2 leads in the usual 4 th intercostal space. All of these patients showed left bundle branch block (LBBB) pattern in limb leads. When precordial V 1 and V 2 leads in the 5 th space were recorded, RBBB pattern changed to LBBB pattern. Biplane chest X‐ray film and echocardiogram, especially 3D echo mode, confirmed that tips of pacing leads of the 4 patients were located in the distal RV septum or the apex. RBBB pattern observed during RV endocardial pacing usually represents safe RV endocardial pacing rather than perforation or malposition of pacing leads.
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Ohnuki et al. (2005) studied this question.
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