title: Right Bundle Branch Block-Like Pattern During Uncomplicated Right Ventricular Pacing and the Effect of Pacing Site.
abstract: Right bundle branch block (RBBB) configuration is an unexpected finding during right ventricular (RV) pacing that raises the suspicion of inadvertent left ventricular lead positioning. The aim of this study was to evaluate the prevalence of paced RBBB pattern in relation to RV lead location. This is a secondary analysis of a prospective, multicenter study, which randomized implantable cardioverter defibrillator recipients to an apical versus midseptal defibrillator lead positioning. A 12-lead electrocardiogram was recorded during intrinsic rhythm and RV pacing. Paced RBBB-like pattern was defined as positive (>0.05 mV) net amplitude of QRS complex in leads V1 and/or V2. In total, 226 patients (65.6 ± 12.0 years, 20.8% women, 53.1% apical site) were included in the study. The prevalence of paced RBBB pattern in the total population was 15.5%. A significantly lower percentage of patients in the midseptal group demonstrated RBBB-type configuration during RV pacing compared with the apical group (1.9% vs 27.5%, p <0.001). Baseline RBBB, prolonged QRS duration during intrinsic rhythm, and reduced ejection fraction were not associated with increased likelihood of paced RBBB. In the subgroup of patients with RBBB type during pacing, 91.4% of patients had a paced QRS axis from -30° to -90°, whereas 100% of patients displayed a negative QRS vector at lead V3. In conclusion, RBBB configuration is encountered in a considerable percentage of device recipients during uncomplicated RV pacing. Midseptal lead positioning is associated with significantly lower likelihood of paced RBBB pattern compared with apical location.
authors.affiliation: Henry Dunant Hospital Center, Department of Cardiology, Athens, Greece. Electronic address: stzeis@otenet.gr.
authors.forename: Stylianos
authors.initials: S
authors.lastname: Tzeis
authors.affiliation: Henry Dunant Hospital Center, Department of Cardiology, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Andrikopoulos
authors.affiliation: Deutsches Herzzentrum München, Klinik für Herz-und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
authors.forename: Severin
authors.initials: S
authors.lastname: Weigand
authors.affiliation: Deutsches Herzzentrum München, Klinik für Herz-und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Grebmer
authors.affiliation: Deutsches Herzzentrum München, Klinik für Herz-und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Semmler
authors.affiliation: Deutsches Herzzentrum München, Klinik für Herz-und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
authors.forename: Amir
authors.initials: A
authors.lastname: Brkic
authors.affiliation: Department of Cardiology and Angiology I, Heart Centre Freiburg University, Freiburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Asbach
authors.affiliation: Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Medizinische, Klinik II, Ruhr Universität Bochum, Bochum, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Kloppe
authors.affiliation: Deutsches Herzzentrum München, Klinik für Herz-und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Lennerz
authors.affiliation: Deutsches Herzzentrum München, Klinik für Herz-und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Bourier
authors.affiliation: Henry Dunant Hospital Center, Department of Cardiology, Athens, Greece.
authors.forename: Sokratis
authors.initials: S
authors.lastname: Pastromas
authors.affiliation: Deutsches Herzzentrum München, Klinik für Herz-und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Kolb
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D048909:Diabetes Complications / Q000503:physiopathology / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D005858:Germany / Q000453:epidemiology; D006115:Greece / Q000453:epidemiology; D006329:Heart Conduction System / Q000503:physiopathology*; D006352:Heart Ventricles; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000628:therapy; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D015995:Prevalence; D011446:Prospective Studies; D012107:Research Design; D012307:Risk Factors; D016896:Treatment Outcome