Pacing Pandemonium: The Unexpected Outcome of Temporary Pacing

Figures

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  FIGURE 1. 12‐lead electrocardiogram of the patient at baseline (A) during catheter placement and immediately after resolution of transient complete heart block intraprocedural (B), on the next day (C).

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  FIGURE 2. (A) 2D‐echocardiogram in modified apical 5‐chamber view showing the temporary pacing catheter penetrating the interventricular septum. Solid arrow—the tip of the temporary pacing catheter; open arrow—metal artifact. (B) Left anterior oblique cranial view showing the temporary catheter being nearly perpendicular to the interventricular septum, and the tip is probably within the left ventricular septal side. Arrows—left ventricular contrast seen crossed by the pacing catheter tip. Ao, aorta; LV, left ventricle; RV, right ventricle.

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  FIGURE 3. (A, B) Schematic representation of the pacing lead (cathode and anode) position in relation to the cardiac conduction system. (C) A temporary pacing catheter tip showing cathode at the tip and anode proximally. IVS, Interventricular septum; LB, left bundle; LV, Left ventricle.

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  FIGURE 4. Paced electrocardiogram morphology was suggestive of non‐selective left bundle capture with isoelectric interval following pacing artifacts, a Qr pattern in lead V1, a short V6 R‐wave peak time (V6RWPT) of < 75 ms, and a prolonged V6–V1 interpeak interval of > 44 ms. The short stimulus‐to‐QRS onset and the short R‐wave peak time in lead V1 (V1RWPT) point towards nsLBBP rather than selective left bundle branch pacing (sLBBP).