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Using the Surface ECG to Identify Right Ventricular Pacing Lead Position: A Cautionary Tale
Author(s) -
KAYE GERALD C.,
ROWE MATTHEW K.,
GOULD PAUL A.
Publication year - 2017
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13065
Subject(s) - medicine , lead (geology) , cardiology , fluoroscopy , ventricular pacing , qrs complex , implant , fixation (population genetics) , electrocardiography , heart failure , surgery , population , environmental health , geomorphology , geology
Chronic right ventricular (RV) apical pacing may lead to the development of heart failure in some patients. Although pacing of the RV septum has been proposed as an alternative, positioning a lead in the true septum has proven challenging. In addition to fluoroscopy at implant, it has been suggested that 12‐lead surface electrocardiogram (ECG) can be used to determine septal lead position; however, studies show this may be inaccurate. We present a case where a change in the ECG QRS axis late after pacemaker insertion with an active fixation lead highlights the difficulties of ECG localization of pacing leads.