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 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 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 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

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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