Key result
A paced right bundle branch block pattern post pacemaker implantation can result from inadvertent left ventricular pacing or other lead placement complications.
Case Report (n=1)
Highlights the differential diagnosis for the unexpected finding of a paced RBBB-pattern QRS following pacemaker implantation, which may indicate lead malposition or perforation.
Right bundle branch block (RBBB) morphology in postpacemaker electrocardiogram (ECG) has been well defined.1 Inadvertent left ventricular pacing following attempted placement of a lead in the right ventricle is a known occurrence. Possible explanations of a paced RBBB-pattern QRS post pacemaker implantation are lead placement in the middle cardiac tributary of the coronary sinus, lead placement via subclavian artery into the left ventricle, lead placement via patent foramen ovale or atrial septal defect or ventricular septal defect into the left ventricle, lead perforation of the right ventricular (RV) apex or interventricular septum, and, rarely, RV apical pacing.
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Agstam et al. (2020) conducted a case report in Alternating bundle branch block pattern post dual-chamber pacemaker implant (n=1). Dual-chamber pacemaker implant was evaluated. A paced right bundle branch block pattern post pacemaker implantation can result from inadvertent left ventricular pacing or other lead placement complications.
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