Monday, November 1, 2021

Determining pacemaker type from EKG (RV pacing vs biventricular pacing)

 Hello, cardiowesomites!

Today we are going to learn how to determine pacemaker type from EKG (RV pacing vs biventricular pacing)

Standard ventricular pacing is from the right ventricle. Hence, most QRS complexes have a left bundle branch block (LBBB) morphology (R to L impulse propagation).  
Leads I, V5, and V6: Tall and broad R wave
V1: Deep QS complex 

Biventricular pacing: If pacing occurs simultaneously or prior to right ventricular pacing, the initial impulse is directed left to right.
Leads I: Large Q wave or QS complex
V1: Tall R wave (can also be present if RV lead is pacing the interventricular septum)

EKGs from the above video are posted below:

Standard RV pacing

Biventricular pacing with frequent PVCs or aberrantly conducted complexes (the second last beat is a fusion beat). The underlying rhythm is atrial fibrillation.

A-V sequential pacing in a patient with a biventricular pacemaker


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