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Malpositioned Pacemaker Lead Presenting as a Peculiar 12-Lead EKG
| Content Provider | Semantic Scholar |
|---|---|
| Author | Nanavati, Amit N. Md, Facc Robert F. Malacoff |
| Copyright Year | 2012 |
| Abstract | A 63-year-old male with a history of dual-chamber pacer implant (St. Jude Medical, St Paul, MN, 5330L Affinity DR) 10 years prior presented to our institution for a routine generator replacement. He had symptoms of dyspnea with exertion and a decreased sense of wellbeing. The dual-chamber pacemaker, presumably with leads in the right atrium and ventricle, was functioning properly. Typically, pacing in the right ventricle leads to a left bundle branch block (LBBB)-like configuration with a widened QRS duration. However, this can be differentiated from a true LBBB in the lateral leads where an RSR' pattern is seen in true LBBB, whereas the QRS morphology is not significantly changed in ''pacing induced LBBB.'' The axis, especially in the inferior leads may be variable depending on the placement of the right ventricular (RV) lead due to the variable ''distance'' from the inferior leads from a lead in the apex, septum, or outflow tract. Pacing in the left ventricle, via a coronary sinus (CS) lead, typically demonstrates a right bundle branch block-like configuration with a large R wave in lead V1. The electrocardiogram (ECG) (Figure 1) shows a fully atrial and ventricular-paced rhythm. However, the ECG does not demonstrate features of a ''pacer induced LBBB.'' Rather, the QRS complex is wide with a large R wave in lead V1, suggestive of a right bundle branch block-like pattern. Furthermore, the QRS axis is significantly rightward, suggesting pacing from a left-sided source. |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://www.innovationsincrm.com/images/pdf/crm-04-06-1266.pdf |
| Alternate Webpage(s) | https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1035&context=medicine&httpsredir=1&referer= |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
