Shift From Left to a Right Bundle Block on ECG Leading to the Diagnosis of a Malpositioned Lead in the Coronary Sinus: A Case Report
| Autor: | Isabel M. McFarlane, Yuvraj S. Chowdhury, Jonathan Francois, Pramod Theetha Kariyanna, Pakinam Mekki, Amog Jayarangaiah |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
right bundle branch pattern medicine.medical_treatment right lead perforation 030204 cardiovascular system & hematology Return of spontaneous circulation Article 03 medical and health sciences QRS complex 0302 clinical medicine pseudo-RBBB Internal medicine medicine Cardiopulmonary resuscitation cardiovascular diseases Coronary sinus General Environmental Science bradyarrhythmia medicine.diagnostic_test Left bundle branch block business.industry dual-chamber pacemaker Right bundle branch block medicine.disease 030221 ophthalmology & optometry Cardiology General Earth and Planetary Sciences Lead Placement business Electrocardiography |
| Zdroj: | American journal of medical case reports |
| ISSN: | 2374-216X 2374-2151 |
| Popis: | On electrocardiography (ECG), ventricular pacing appears as a spikes that precede induced QRS complexes. The induced complexes with a right ventricular lead have the morphology of a left bundle branch block (LBBB). We describe a case of malposition right ventricular (RV) lead in the coronary sinus diagnosed based on the changes noted in the ECG tracing. An 80-year-old man with a pacemaker implanted for high-grade AV block was found unresponsive. Six minutes of cardiopulmonary resuscitation resulted in return of spontaneous circulation. The ECG demonstrated a new paced right bundle branch block (RBBB) pattern. Chest radiography revealed a misplaced right ventricular (RV) lead in the coronary sinus which was confirmed by 2D-echocardiography. The patient’s healthcare proxy (HCP) declined invasive interventions. The patient expired due multiorgan failure secondary to ventilator associated pneumonia. When an RBBB pattern is seen with RV pacing, patients must be evaluated for mispositioning of the RV lead navigation through an atrial septal defect (ASD) or perforation of the ventricular septum, aberrant retrograde conduction, pre-existing right bundle disease and the “pseudo-RBBB” pattern (seen with the ventricular lead placed in the RV apex/distal septum). A frontal axis of 0˚ to 90˚ and precordial transition by lead V3 differentiates RV septal pacing from all forms of LV pacing, including lead placement in the coronary sinus. Our patient had precordial transition at V3. |
| Databáze: | OpenAIRE |
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