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Image challenge
Pacing: a new look. Don’t be deceived
  1. Chee Loong Chow1,2,
  2. Barveen Abu Baker1,
  3. Uwais Mohamed1,2
  1. 1 Department of Cardiology, Northern Hospital, Epping, Victoria, Australia
  2. 2 Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Dr Uwais Mohamed, Department of Cardiology, Northern Hospital, Epping, VIC 3076, Australia; uwais.mohamed{at}nh.org.au

Abstract

Clinical introduction A 78-year-old man presents following a syncopal episode in the setting of intermittent sinus bradycardia and left bundle branch block (LBBB). With symptoms likely due to documented intermittent sinus node dysfunction, and finding of a diseased left bundle, a pacemaker was inserted (online supplementary figure 1 shows the electrode position in a PA fluroscopy view). His baseline ECG is shown in figure 1A, with a QRS width of 160 ms, and his echocardiogram revealed a left ventricular ejection fraction of 45%. His ECG day 1 postdevice insertion is shown in figure 1B. His device check confirmed excellent function. His QRS width on ECG postdevice insertion is now normalised to 80 ms.

Supplementary file 1

Question What type of device therapy has this patient received?

  1. Biventricular pacing.

  2. Right ventricular outflow septal pacing.

  3. His bundle pacing.

  4. Right ventricular apical pacing.

Question

Figure 1
Figure 1

(A) Baseline ECG and (B) day 1 postpacemaker implantation.

  • pacemakers
  • Ecg/electrocardiogram

http://dx.doi.org/10.1136/heartjnl-2018-313392

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    Footnotes

    • Contributors All authors have substantial contribution to the conception, writing and editing of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.