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

2021 ◽  
Vol 18 (1) ◽  
pp. 1-6
Author(s):  
Vijay Yadav ◽  
Ratna Mani Gajurel ◽  
Chandra Mani Poudel ◽  
Hemant Shrestha ◽  
Surya Devkota ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Right Bundle Branch Block ◽  
High Sensitivity ◽  
S Wave ◽  
Bundle Branch Block ◽  
Rv Pacing ◽  
Wall Perforation ◽  
The Right ◽  
Sensitivity Specificity ◽  
Endocardial Pacing

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.

scholarly journals Right bundle branch block pattern in right ventricular endocardial pacing: A needless concern?

Heart India ◽  
2013 ◽  
Vol 1 (2) ◽  
pp. 57
Author(s):  
MangalachulliPottammal Ranjith ◽  
Kalathingathodika Sajeer ◽  
ChakanalilGovindan Sajeev ◽  
Cicy Bastian ◽  
Vellani Haridasan ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Right Bundle Branch Block ◽  
Bundle Branch Block ◽  
Block Pattern ◽  
Endocardial Pacing

scholarly journals Electrocardiography changes and their significance during treatment of patients with intermediate-high and high-risk pulmonary embolism

2019 ◽  
Vol 9 (4) ◽  
pp. 271-278
Author(s):  
Natasha Novicic ◽  
Boris Dzudovic ◽  
Bojana Subotic ◽  
Sonja Shalinger-Martinovic ◽  
Slobodan Obradovic
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Right Ventricular ◽  
Right Bundle Branch Block ◽  
Systolic Pressure ◽  
S Wave ◽  
Right Ventricular Systolic Pressure ◽  
Bundle Branch Block ◽  
Ventricular Systolic Pressure ◽  
Block Pattern

Background: Electrocardiography (ECG) signs, typical or acute pulmonary embolism, and their changes can be used for the prediction of clinical and haemodynamic outcomes. Purpose: To study the predictive value of the resolution of admission ECG signs in higher risk pulmonary embolism patients for 30-day survival and for the decrease in right ventricular systolic pressure. Methods: We analysed the 12-lead ECGs at admission and daily for the first 5 days after hospitalisation in 110 intermediate-high and high-risk pulmonary embolism patients admitted to the intensive care unit of a single tertiary centre. The predictive value of the resolution of four ECG signs were analysed for 30-day survival and for the changes in right ventricular systolic pressure during hospitalisation: S-wave in the first standard lead, right bundle branch block pattern, S-wave in the aVL lead and negative T-waves in precordial leads. Results: ECG recordings showed the existence of S-wave in the I lead in 71 (64.5%), S-wave in the aVL in 77 (70%), right bundle branch block pattern in 30 (27.3%) and negative T-waves in 66 (60%) patients. All-cause 30-day in-hospital mortality was 13.6%. Among the ECG signs, only the presence of right bundle branch block at admission was significantly associated with 30-day all-cause mortality (hazard ratio (HR) adjusted for age, gender and right ventricular systolic pressure at admission was 7.7, 95% confidence interval (CI) 2.1–27.9; P=0.002). The resolution of three ECG signs during the first 5 days of hospitalisation, S-wave in the I lead (HR 26.4, 95% CI 3.1–226.6; P=0.003), S-wave in the aVL (HR 21.5, 95% CI 2.6–175.3; P=0.004) and right bundle branch block configuration (HR 5.2, 95% CI 1.3–20.8; P=0.020) were associated with 30-day survival. The intermediate-high and high-risk pulmonary embolism patients with S-wave resolution in lead aVL had 0.0% and 7.1% 30-day all-cause mortality, respectively. The patients with resolution of the S-wave in the first lead and in aVL as well as right bundle branch block had more pronounced changes in right ventricular systolic pressure at discharge (27±13 vs. 13±15 mmHg; P=0.011 for S-wave in I lead resolution, 27±12 vs. 15±17 mmHg; P=0.004 for S-wave in aVL resolution and 23±14 vs. 9±14 mmHg; P=0.040 for right bundle branch block resolution) than patients without resolution. Conclusion: Resolution of S-waves and right bundle branch block in ECG correlates with lower all-cause 30-day mortality in intermediate-high and high-risk pulmonary embolism patients. Resolution of S-waves in the first lead and in aVL and right bundle branch block correlates with a decrease of right ventricular systolic pressure.

scholarly journals ECG changes in COVID-19

Kardiologiia ◽  
2020 ◽  
Vol 60 (8) ◽  
pp. 16-22
Author(s):  
G. V. Ryabykina
Keyword(s):  
Right Ventricular ◽  
Right Bundle Branch Block ◽  
Community Acquired Pneumonia ◽  
P Wave ◽  
Research Centre ◽  
Bundle Branch Block ◽  
National Medical ◽  
Myocardial Stress ◽  
Coronavirus Infection ◽  
The Right

Aim      To evaluate changes in 12-lead ECG in patients with coronavirus infection.Materials and methods This article describes signs of electrocardiographic right ventricular “stress” in patients with COVID-19. 150 ECGs of 75 COVID-19 patients were analyzed in the Institute of Cardiology of the National Medical Research Centre for Therapy and Preventive Medicine. The diagnosis was based on the clinical picture of community-acquired pneumonia, data of chest multispiral computed tomography, and a positive test for COVID-19. ECG was recorded both in 3-6 and in 12 leads. Signs of right ventricular (RV) stress, so-called systolic overload (high R and inverted TV1–3 and TII, III, aVF), and diastolic overload (RV wall hypertrophy and cavity dilatation; complete or incomplete right bundle branch block) were evaluated.Results The most common signs for impaired functioning of the right heart include emergence of the RV P wave phase (41.3 %), incomplete right bundle branch block (42.6 %), ECG of the SIQ IIITIII type (33.3 %) typical for thromboembolic complications, and signs of RV hypertrophy, primarily increased SV5–6 (14.7 %). These changes are either associated with signs of RV myocardial stress (16 %) or appear on the background of signs for diffuse hypoxia evident as tall, positive, sharp-ended T waves in most leads (28 %).Conclusion      A conclusive, comprehensive assessment of the reversal of hemodynamic disorders and electrocardiographic dynamics in patients with COVID-19 will be possible later, when more data become available.

scholarly journals Right Bundle Branch Block Like Pattern Recorded in Right Ventricular Endocardial Pacing

2005 ◽  
Vol 21 (3) ◽  
pp. 414-417 ◽  
Author(s):  
Masahiro Ohnuki ◽  
Kazuhiko Miyataka ◽  
Takehiko Nakamura ◽  
Yoshinobu Ohnishi ◽  
Yoshizumi Kohnoike ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Right Bundle Branch Block ◽  
Bundle Branch Block ◽  
Endocardial Pacing

scholarly journals Bilateral Bundle Branch Area Pacing to Achieve Physiological Conduction System Activation

2020 ◽  
Vol 13 (8) ◽  
Author(s):  
Jinxuan Lin ◽  
Keping Chen ◽  
Yan Dai ◽  
Qi Sun ◽  
Yuqiu Li ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Right Bundle Branch Block ◽  
Left Ventricular ◽  
Conduction System ◽  
Conduction Delay ◽  
Activation Time ◽  
Bundle Branch Block ◽  
Ventricular Activation ◽  
Qrs Duration ◽  
The Right

Background: Left bundle branch pacing (LBBP) is a technique for conduction system pacing, but it often results in right bundle branch block morphology on the ECG. This study was designed to assess simultaneous pacing of the left and right bundle branch areas to achieve more synchronous ventricular activation. Methods: In symptomatic bradycardia patients, the distal electrode of a bipolar pacing lead was placed at the left bundle branch area via a transventricular-septal approach. This was used to pace the left bundle branch area, while the ring electrode was used to pace the right bundle branch area. Bilateral bundle branch area pacing (BBBP) was achieved by stimulating the cathode and anode in various pacing configurations. QRS duration, delayed right ventricular activation time, left ventricular activation time, and interventricular conduction delay were measured. Pacing stability and short-term safety were assessed at 3-month follow-up. Results: BBBP was successfully performed in 22 of 36 patients. Compared with LBBP, BBBP resulted in greater shortening of QRS duration (109.3±7.1 versus 118.4±5.7 ms, P <0.001). LBBP resulted in a paced right bundle branch block configuration, with a delayed right ventricular activation time of 115.0±7.5 ms and interventricular conduction delay of 34.0±8.8 ms. BBBP fully resolved the right bundle branch block morphology in 18 patients. In the remaining 4 patients, BBBP partially corrected the right bundle branch block with delayed right ventricular activation time decreasing from 120.5±4.7 ms during LBBP to 106.1±4.2 ms during BBBP ( P =0.005). Conclusions: LBBP results in a relatively narrow QRS complex but with an interventricular activation delay. BBBP can diminish the delayed right ventricular activation, producing more physiological ventricular activation. Graphic Abstract: A graphic abstract is available for this article.

Abstract P64: Right Ventricular Outflow Septal Pacing as Cardiac Resynchronization Therapy in Patients with Right Bundle-Branch Block: Results in 62 Patients

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Phillip E Schrumpf ◽  
Michael Giudici ◽  
Deborah Paul ◽  
Roselyn Krupa ◽  
Cynthia Meirbachtol
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Right Ventricular ◽  
Right Bundle Branch Block ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Qrs Complex ◽  
Resynchronization Therapy ◽  
Ventricular Performance ◽  
Bundle Branch Block ◽  
Qrs Duration

Background: Cardiac resynchronization therapy has been shown to improve left ventricular performance in patients with left ventricular dysfunction and a left-sided interventricular conduction delay. This is performed by placing a pacing lead on the lateral left ventricular wall to stimulate the area normally stimulated by the left bundle branch. In patients with right bundle branch block (RBBB), pacing the right bundle branch could also result in resynchronization. Previous studies have shown that right ventricular outflow septal (RVOS) pacing does, in fact, utilize the native conduction system. Methods: 62 consecutive patients, 46 male/16 female, aged 75 +/− 10.5 yr, with RBBB and indications for pacing, underwent RVOS lead placement using commercially available pacing systems. The patients subsequently underwent bedside A-V optimization to achieve the narrowest QRS duration and most “normal” QRS complex. Echocardiography was performed to evaluate changes in wall motion comparing baseline with optimal pacing. Results: Baseline mean QRS duration 146 +/− 20.9 ms Optimized mean QRS duration 111 +/− 20.5 ms Average decrease in QRS duration -35 +/− 21.5 ms p < 0.001 Echocardiography demonstrated improvement in septal contraction abnormalities. Conclusions: 1) RVOS pacing in RBBB patients can significantly narrow the QRS complex on ECG. 2) Septal contraction abnormalities due to RBBB can be improved with RVOS pacing and optimal A-V timing. 3) Further studies are warranted to evaluate this therapy in a heart failure population.

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