Right bundle branch block (RBBB)-like pattern during right ventricular pacing

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  • ペースメーカ植込み患者における，右脚ブロック様波形を示した症例

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<p>The QRS complex of the pacemaker best resembles a typical left bundle branch block (LBBB) during right ventricle (RV) pacing. The right bundle branch block (RBBB)-like pattern implies an abnormal lead position or perforation of the RV. We performed electrocardiogram (ECG) recording and encountered a case of RBBB-like pattern. An abnormal lead position was ruled out by chest X-ray and echocardiogram examinations, confirming the apical right ventricular lead position. It has been reported that an uncomplicated RV produces an RBBB-like pattern. We investigated the position of the lead in one intercostal space lower than the usual space of the chest electrode, and determined the frontal axis and precordial point of transition. Our patient also showed the RBBB-like pattern in one intercostal space lower than the usual space of the chest electrode. The frontal axis was −30°, the precordial point of transition was between V1 and V2, and there was no difference in the reported ECG algorithms. ECG is useful for detecting the abnormal position of the right ventricular lead.</p>

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