Inadvertent permanent ventricular pacing from the coronary vein: An electrocardiographic, roentgenographic, and echocardiographic assessment

Shettigar, U. R.; Loungani, Ramesh R.; Smith, Charles A.

doi:10.1002/clc.4960120508

Cited by 23 publications

(12 citation statements)

References 22 publications

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“…Hence the presence of a right bundle branch block pattern after implantation should raise suspicion for a misplacement of leads, as was the case in our patient. However, one should remember that this right bundle branch block pattern can also be seen in the case of lead placement in the coronary sinus10,11 or even occasionally in the apical region of the right ventricle 12,13. Chest X-ray with posterior-anterior and lateral views can provide supplementary diagnostic arguments, as was the case in our patient.…”

Section: Discussionsupporting

confidence: 66%

Sinus venosus atrial septal defect: a rare cause of misplacement of pacemaker leads

Bodian

Aw²,

Bamba³

et al. 2013

IMCRJ

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Routine implantation of pacemakers and implantable cardioverter defibrillators is not commonly associated with complications. However, in some cases we see misplacement of pacemaker leads which is most often related to the presence of underlying cardiac anomalies. We report the case of misplacement of a pacemaker lead into the left ventricle of a 56-year-old patient paced in VVI/R mode and with a tined type pacemaker lead because of a symptomatic complete atrioventricular block. Electrocardiogram showed a pacemaker-generated rhythm with a right bundle branch block pattern. Chest X-ray showed the pacemaker lead located relatively high in relation to the diaphragm. Echocardiography visualized the pacemaker lead in the left heart chambers (atrium and ventricle), hence confirming its aberrant course. Further, the defect causing its passage to the left heart chambers was a sinus venosus atrial septal defect. The patient reported no complication related to the misplacement of the lead. After a brief period of oral anticoagulation, the lead was inserted into the right ventricle by percutaneous technique.

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Section: Discussionsupporting

confidence: 66%

Sinus venosus atrial septal defect: a rare cause of misplacement of pacemaker leads

Bodian

Aw²,

Bamba³

et al. 2013

IMCRJ

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“…Previous reports have suggested that pacing from the MCV usually produces an RBBB pattern, though an LBBB configuration has been less commonly described 3–7 . In contrast, we registered an LBBB pattern during MCV pacing in all our seven patients.…”

Section: Discussioncontrasting

confidence: 50%

“…We cannot compare our data with the reported RBBB patterns during MCV pacing, because we paced from the mid‐portion of the MCV and avoided the distal branches, some of which wrapped around the LV and may have produced an RBBB pattern. However, the reported occurrence of intermittent LBBB and RBBB paced patterns soon after implantation of a lead in the MCV suggests that movement of an unstable lead can produce an RBBB pattern proximally and an LBBB pattern more distally in the MCV 3 . Furthermore, available limited radiographic data suggests a proximal MCV pacing site in the previous reports 4,6 .…”

Section: Discussionmentioning

confidence: 94%

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Electrocardiographic Patterns during:

Giudici

Tigrett

Carlson

et al. 2007

Pacing Clinical Electrophis

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Pacing within the GCV resulted in a left bundle branch block (LBBB) morphology with no or minimal R-wave in V(1) in 14 patients and a right bundle branch block (RBBB) pattern (R > S in lead V(1)) in four patients. In one patient, lead V1 during GCV pacing was isoelectric (R = S). A more distal pacing site in the GCV yielded a LBBB pattern in all the patients. All leads placed in the MCV resulted in a LBBB configuration. An ECG pattern with a RBBB pattern was invariably recorded during LV pacing in 125 consecutive outpatients with biventricular pacemakers and LV leads in the posterolatral and lateral coronary veins. Knowledge of the ECG patterns from various pacing sites in the coronary venous system may be helpful for troubleshooting all types of pacing systems, especially those where the coronary venous pacing site is unintentional.

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“…The access sites to the LV can be easily identified by the typical widespread RBBB pattern in the precordial leads during pacing, standard chest radiographs, and echocardiography. 14,[22][23][24][25][26] As a rule with a RBBB configuration (tall R wave in V3 and beyond), the frontal plane axis cannot differentiate precisely an endocardial LV site from one in the coronary venous system.…”

Section: Left Ventricular Endocardial Pacingmentioning

confidence: 99%

Electrocardiographic Follow‐Up of Biventricular Pacemakers

Barold¹,

Herweg²,

Giudici³

2005

Noninvasive Electrocardiol

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Multisite pacing for the treatment of heart failure has added a new dimension to the electrocardiographic evaluation of device function. During left ventricular (LV) pacing from the appropriate site in the coronary venous system, a correctly positioned lead V1 registers a right bundle branch block pattern with few exceptions. During biventricular stimulation associated with right ventricular (RV) apical pacing, the QRS is often positive in lead V1. The frontal plane QRS axis is usually in the right superior quadrant and occasionally in the left superior quadrant. Barring incorrect placement of lead V1 (too high on the chest), lack of LV capture, LV lead displacement or marked latency (exit block or delay from the stimulation site), ventricular fusion with the spontaneous QRS complex, a negative QRS complex in lead V1 during biventricular pacing involving the RV apex probably reflects different activation of an heterogeneous biventricular substrate (ischemia, scar, His-Purkinje participation in view of the varying patterns of LV activation in spontaneous left bundle branch block) and does not necessarily indicate a poor (electrical or mechanical) contribution from LV stimulation. In this situation, it is imperative to rule out the presence of coronary venous pacing via the middle cardiac vein or even unintended placement of two leads in the RV. During biventricular pacing with the RV lead in the outflow tract, the paced QRS in lead V1 is often negative and the frontal plane paced QRS axis is often directed to the right inferior quadrant (right axis deviation). In patients with sinus rhythm and a relatively short PR interval, ventricular fusion with competing native conduction during biventricular pacing may cause misinterpretation of the ECG because narrowing of the paced QRS complex simulates appropriate biventricular capture. This represents a common pitfall in device follow-up. Elimination of ventricular fusion by shortening the AV delay, is often associated with clinical improvement. Anodal stimulation may complicate threshold testing and should not be misinterpreted as pacemaker malfunction. One must be cognizant of the various disturbances that can disrupt 1:1 atrial tracking and cause loss of ventricular resynchronization. (1) Upper rate response. The upper rate response of biventricular pacemakers differs from the traditional Wenckebach upper rate response of conventional antibradycardia pacemakers because heart failure patients generally do not have sinus bradycardia or AV junctional conduction delay. The programmed upper rate should be sufficiently fast to avoid loss of resynchronization in situations associated with sinus tachycardia. (2) Below the programmed upper rate. This may be caused by a variety of events (especially ventricular premature complexes and favored by the presence of first-degree AV block) that alter the timing of sensed and paced events. In such cases, atrial events become trapped into the postventricular atrial refractory period at atrial rates below the programmed upper rate in the...

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Inadvertent permanent ventricular pacing from the coronary vein: An electrocardiographic, roentgenographic, and echocardiographic assessment

Cited by 23 publications

References 22 publications

Sinus venosus atrial septal defect: a rare cause of misplacement of pacemaker leads

Sinus venosus atrial septal defect: a rare cause of misplacement of pacemaker leads

Electrocardiographic Patterns during:

Electrocardiographic Follow‐Up of Biventricular Pacemakers

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