Key result
Right ventricular apical pacing can rarely result in a benign, uncomplicated right bundle branch block pattern on ECG, distinguishable from complicated pacing by frontal QRS axis and precordial transition.
Case Report (n=1)
No
An RBBB pattern on ECG after RV apical pacing can occur despite correct lead placement, potentially due to anomalous pathways, retrograde conduction, or diseased RV conduction system.
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RBBB after RV apical pacing may not indicate perforation; this level-5 observation leaves open alternative mechanisms.
Right ventricular (RV) apical pacing results in left bundle branch block pattern with left axis deviation in electrocardiogram (ECG). Appearance of right bundle branch block (RBBB) pattern on electrocardiogram after RV apical pacing commonly denotes septal perforation or coronary sinus pacing. 59 year old male underwent permanent pacemaker implantation (VVI) for symptomatic complete heart block with tined pacing lead fixed in right ventricular apex. 12 lead ECG showed RBBB pattern after implantation, despite the lead in RV apex. Some of the mechanisms proposed are incorrect lead placement, left ventricle getting activated first through anomalous pathways, pacing stimulus travelling through right bundle to atrioventricular node retrogradely and down the left bundle branch and lastly diseased right ventricular conduction system leading the pacing stimulus to penetrate left ventricular conduction system early.
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G. Gnanavelu (2018) conducted a case report in Symptomatic complete heart block (n=1). Right ventricular apical pacing was evaluated on Electrocardiographic pattern following pacemaker implantation. Right ventricular apical pacing can rarely result in a benign, uncomplicated right bundle branch block pattern on ECG, distinguishable from complicated pacing by frontal QRS axis and precordial transition.
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