title: [Right bundle-branch block configuration in the pacemaker ECG--3 different observations].
abstract: We report on 3 cases of right bundle branch block configuration in the ECG after pacemaker implantation. In case 1 it was not noticed that the catheter had been directed through an unknown sinus venosus defect into the left atrium and the left ventricle. In case 2 the catheter reached the left ventricle via an iatrogenic perforation of the lower part of the atrial septum. In case 3 the catheter was situated correctly in the right ventricle, but the tip was penetrating the septum. Different possibilities of interpretation of this phenomenon are discussed, and a description of further pacemaker catheter misplacements which may be responsible for a right bundle branch block configuration is given. The authors take the view that a pacemaker catheter should not remain in the arterial area, in the pericardial space and in the coronary sinus. A lateral radiograph, a 12-lead ECG and an echocardiographic study are helpful for detecting and interpreting an unusual catheter position or a right bundle branch block configuration in the pacemaker ECG.
mesh_terms: D000368:Aged; D001919:Bradycardia / Q000628:therapy; D002036:Bundle of His / Q000503:physiopathology; D002037:Bundle-Branch Block / Q000503:physiopathology*; D002408:Catheters, Indwelling; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000628:therapy; D006346:Heart Septum / Q000293:injuries; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012804:Sick Sinus Syndrome / Q000628:therapy
vernacular_title: Rechtsschenkelblock-Konfiguration im Schrittmacher-EKG--3 unterschiedliche Beobachtungen.