Right Bundle Branch Block Morphology After Right Ventricular Endocardial Pacing – When Should a Cardiologist Begin to Worry ?

Authors

  • Vijay Yadav Department of Cardiology, Manmohan Cardiothoracic and Vascular Transplant Centre, Tribhuvan University, Institute of Medicine, Kathmandu, 44600, Nepal. http://orcid.org/0000-0002-3837-3828
  • Ratna Mani Gajurel Department of Cardiology, Manmohan Cardiothoracic and Vascular Transplant Centre, Tribhuvan University, Institute of Medicine, Kathmandu, 44600, Nepal.
  • Chandra Mani Poudel Department of Cardiology, Manmohan Cardiothoracic and Vascular Transplant Centre, Tribhuvan University, Institute of Medicine, Kathmandu, 44600, Nepal.
  • Hemant Shrestha Department of Cardiology, Manmohan Cardiothoracic and Vascular Transplant Centre, Tribhuvan University, Institute of Medicine, Kathmandu, 44600, Nepal.
  • Surya Devkota Department of Cardiology, Manmohan Cardiothoracic and Vascular Transplant Centre, Tribhuvan University, Institute of Medicine, Kathmandu, 44600, Nepal.
  • Sanjeev Thapa Department of Cardiology, Manmohan Cardiothoracic and Vascular Transplant Centre, Tribhuvan University, Institute of Medicine, Kathmandu, 44600, Nepal.
  • Raja Ram Khanal Department of Cardiology, Manmohan Cardiothoracic and Vascular Transplant Centre, Tribhuvan University, Institute of Medicine, Kathmandu, 44600, Nepal.
  • Smriti Shakya Department of Cardiology, Manmohan Cardiothoracic and Vascular Transplant Centre, Tribhuvan University, Institute of Medicine, Kathmandu, 44600, Nepal.
  • Shovit Thapa Department of Cardiology, Manmohan Cardiothoracic and Vascular Transplant Centre, Tribhuvan University, Institute of Medicine, Kathmandu, 44600, Nepal.
  • Manju Sharma Department of Cardiology, Manmohan Cardiothoracic and Vascular Transplant Centre, Tribhuvan University, Institute of Medicine, Kathmandu, 44600, Nepal.
  • Suman Adhikari Department of Cardiology, Manmohan Cardiothoracic and Vascular Transplant Centre, Tribhuvan University, Institute of Medicine, Kathmandu, 44600, Nepal.

DOI:

https://doi.org/10.3126/njh.v18i1.36767

Keywords:

Right Bundle Branch Block Morphology, Right Ventricular Endocardial Pacing.

Abstract

Even though the left bundle branch block (LBBB) morphology in the surface electrocardiogram (ECG) is expected after right ventricular endocardial pacing, the right bundle branch block (RBBB) morphology may be paradoxically seen in around 8 to 10% of patients. The paced RBBB morphology should be given special attention in terms of safe RV pacing or septal and free wall perforation. Simple techniques such as moving the leads V1-2 to one interspace lower than standard (Klein maneuver) and combining frontal QRS axis between -30° to -90°, precordial transition point at or within V3, and absence of S wave in lead I as an algorithmic approach may correctly identify the pacemaker lead in right ventricle with high sensitivity, specificity, and positive predictive value.

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Published

2021-04-30

How to Cite

Yadav, V., Gajurel, R. M., Poudel, C. M., Shrestha, H., Devkota, S., Thapa, S., Khanal, R. R., Shakya, S., Thapa, S., Sharma, M., & Adhikari, S. (2021). Right Bundle Branch Block Morphology After Right Ventricular Endocardial Pacing – When Should a Cardiologist Begin to Worry ?. Nepalese Heart Journal, 18(1), 1–6. https://doi.org/10.3126/njh.v18i1.36767

Issue

Vol. 18 No. 1 (2021)

Section

Review Articles

License

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