Unusual QRS Wave Forms Associated with Permanent Pacemakers

¹ The Department of Medicine, University of Utah College of Medicine and the Salt Lake Veterans Administration Hospital, Salt Lake City, Utah

Electrocardiograms from 86 patients with permanent pacemakers were reviewed to assess the frequency of unusual QRS configurations associated with properly placed pacemaker catheters. All nine patients with epicardial pacemaker wires had the expected QRS configuration, suggesting that the contralateral ventricle was depolarized last. Electrocardiograms from 71 of 77 patients with transvenous pacemakers showed the expected left bundle branch block type configuration. Six patients had unexpected QRS morphology, manifested either as typical rightbundle branch block morphology or as a prominent R wave of RsR' pattern in lead V₁. Clinical evaluation including lateral chest x-ray film findings revealed no evidence of cather malposition in these six patients, and two with appropriate catheter position confirmed by direct visualization. These results suggest that unusual QRS configurations as described are not uncommonly associated with parmanent transvenous pacemakers, and need not always imply inappropriate catheter position. Possible machanisms of the unusual QRS configurations are discussed.

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