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Evaluation of intermittent capture in a patient who has undergone an urgent temporary transvenous pacemaker lead insertion
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The post-procedure ECG shows paced rhythm with complete right bundle branch block morphology and right inferior axis shift (fig 1 below: RR’ complex in V1; QS complex in S1, aVL and V5; R in aVR and aVF). If one sees such an ECG pattern in a paced patient, then one must think of a malpositioned lead that stimulates the heart from the left ventricle.
The fluoroscopic view taken after temporary pacemaker lead insertion clearly shows a malpositioned temporary pacemaker lead (fig 2 marked as B) in the coronary sinus and another lead in the right ventricle (fig 2 marked as A). The left anterior oblique view is especially important to locate and verify the course of the lead that goes to the left side of the heart. As is seen on the right anterior oblique view, the tip of the lead lies on the epicardial surface of the left ventricle.
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