title: Using the Surface ECG to Identify Right Ventricular Pacing Lead Position: A Cautionary Tale.
abstract: Chronic right ventricular (RV) apical pacing may lead to the development of heart failure in some patients. Although pacing of the RV septum has been proposed as an alternative, positioning a lead in the true septum has proven challenging. In addition to fluoroscopy at implant, it has been suggested that 12-lead surface electrocardiogram (ECG) can be used to determine septal lead position; however, studies show this may be inaccurate. We present a case where a change in the ECG QRS axis late after pacemaker insertion with an active fixation lead highlights the difficulties of ECG localization of pacing leads.
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|The School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Gerald C
authors.initials: GC
authors.lastname: Kaye
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|The School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Matthew K
authors.identifier: http://orcid.org/0000-0002-6931-8805
authors.initials: MK
authors.lastname: Rowe
authors.affiliation: Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|The School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gould
mesh_terms: D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000379:methods
keywords: electrocardiogram; pacing; septal pacing