title: Safe right bundle branch block pattern during permanent right ventricular pacing.
abstract: It is known that an electrocardiogram (ECG) after transvenous right ventricular (RV) pacing should yield left bundle branch block (LBBB) QRS patterns. When right bundle branch block (RBBB) pacing morphology appears in a patient with a permanent or temporary transvenous RV pacemaker, myocardial perforation or malposition of the pacing lead must be ruled out, even though the patient may be asymptomatic. We report a case of a 77-year-old man who underwent permanent transvenous VDD pacemaker implantation for symptomatic heart block. The postoperative ECG revealed a RBBB pacing configuration, but his chest X-ray and echocardiographic studies confirmed uncomplicated RV pacing. We review and discuss the literature concerning the differential diagnosis of such a safe RBBB ECG pattern.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Armed Forces Sung-Shan Hospital, Taipei, Taiwan, R.O.C.
authors.forename: Yung-Nien
authors.initials: YN
authors.lastname: Yang
authors.forename: Wei-Hsian
authors.initials: WH
authors.lastname: Yin
authors.forename: Mason Shing
authors.initials: MS
authors.lastname: Young
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D004452:Echocardiography; D004562:Electrocardiography; D006327:Heart Block / Q000628:therapy; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D011859:Radiography