Key result
An apparent right bundle branch block pattern during right ventricular pacing was confirmed as a pseudo-RBBB by moving ECG leads V1 and V2 one intercostal space lower, restoring the expected left bundle branch block pattern.
Case Report (n=1)
No
An apparent RBBB pattern during RV pacing can be a pseudo-malposition artifact that resolves by lowering V1 and V2 leads by one intercostal space.
Apparent RBBB during RV pacing may warrant V1-V2 lead adjustment; hypothesis-generating case report requiring prospective confirmation.
We present the case of a 72-year-old male who underwent a permanent transvenous DDD pacemaker implantation for symptomatic complete heart block. The postoperative surface electrocardiogram (ECG) revealed a right bundle branch block (RBBB) pacing pattern with transition in lead V3 and left bundle branch block (LBBB) in D1, suggesting a malpositioned ventricular lead in the left heart. Malposition of a lead was ruled out by chest X-ray and echocardiogram confirming apical right ventricular pacing. After a literature review, a surface ECG maneuver, by placing leads V1 and V2 one intercostal space lower, restored the usual patterns of paced LBBB pattern. We discuss the literature concerning safe-paced RBBB.
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Errahmouni et al. (2013) conducted a case report in Symptomatic complete heart block (n=1). Permanent transvenous DDD pacemaker implantation was evaluated on ECG pacing pattern. An apparent right bundle branch block pattern during right ventricular pacing was confirmed as a pseudo-RBBB by moving ECG leads V1 and V2 one intercostal space lower, restoring the expected left bundle branch block pattern.
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