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Pacing: a new look. Don’t be deceived


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.


Figure 1

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

  • pacemakers
  • Ecg/electrocardiogram

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