Key result
Right ventricular endocardial pacing can present with an RBBB pattern on ECG despite appropriate lead positioning at the RV apex, mimicking a lead perforation.
Case Report (n=1)
An RBBB pattern during RV endocardial pacing can occur with appropriate lead placement and does not definitively indicate lead perforation.
RBBB pattern during RV apical pacing does not confirm perforation; case report leaves open need for imaging confirmation.
Right ventricular (RV) endocardial pacing in permanent pacemaker implantation usually yields a left bundle branch block (LBBB) pattern in surface electrocardiogram (ECG). The presence of right bundle branch block (RBBB) pattern raises the suspicion of lead perforation. We report a case of RV endocardial permanent pacemaker implantation showing a RBBB pattern in ECG, suggesting a complication. However, further work-up revealed that the lead was appropriately located at the RV apex.
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Ranjith et al. (2013) conducted a case report in Right ventricular endocardial permanent pacemaker implantation with RBBB pattern (n=1). Right ventricular endocardial pacing was evaluated on Lead location and complication assessment. Right ventricular endocardial pacing can present with an RBBB pattern on ECG despite appropriate lead positioning at the RV apex, mimicking a lead perforation.
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