Skip to main content
main-content

01.12.2014 | Case report | Ausgabe 1/2014 Open Access

Journal of Medical Case Reports 1/2014

Separated right and left ventricular excitation during right ventricular septal pacing in a patient with narrow QRS wave: a case report

Zeitschrift:
Journal of Medical Case Reports > Ausgabe 1/2014
Autoren:
Takanori Yaegashi, Hiroshi Furusho, Akio Chikata, Soichiro Usui, Shuichi Kaneko, Masakazu Yamagishi, Masayuki Takamura
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1752-1947-8-158) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

TY analyzed and interpreted patient data including cardiac electrophysiological mapping, and was the major contributor in writing the manuscript. HF and AC performed most medical patient care including ICD implantation and management. SU and MT contributed in electrophysiological and circulatory interpretation. SK and MY provided major diagnostic and therapeutic suggestions, especially on patient care. All authors read and approved the final manuscript.

Abstract

Introduction

Right ventricular septal pacing is thought to be better than right ventricular apical pacing for shortening the QRS duration and for preserving left ventricular function. However, right ventricular septal pacing may not be effective in all cases. In this case report, we present a rare case in which right ventricular septal pacing induced thoroughly separated right and left ventricular excitation despite the presence of a relatively narrow QRS wave during atrium-only pacing.

Case presentation

We report a case of 63-year-old Japanese man with cardiomyopathy with an implantable cardioverter defibrillator placement for ventricular tachycardia. Three years after implantation, he developed second-degree atrio-ventricular block. Therefore, atrio-ventricular sequential pacing was started; then his heart failure was much worsened. His electrocardiogram showed a dissociated biphasic QRS wave during right ventricular high-septal pacing, despite the presence of a non-fragmented QRS morphology during atrium-only pacing. An activation map during right ventricular high-septal pacing showed that right ventricular conduction started at the pacing site and ended at the right ventricular basal inferior site. Subsequently after a 10ms interval, left ventricular conduction started at the left ventricular posteroseptum and ended at the left ventricular lateral wall. These data indicate that during right ventricular high-septal pacing, the first component of the QRS wave supposedly reflects only right ventricular excitation and the second component only left ventricular excitation. Also due to the intracardiac electrograms, it was assumed that this phenomenon was caused by transversely limited severe transseptal conduction disturbance.

Conclusion

It should be noted that even ventricular septal pacing could evoke harmful interventricular dyssynchrony due to transversely limited severe septal conduction disturbance, despite the presence of a relatively narrow QRS wave.

Unsere Produktempfehlungen

e.Med Interdisziplinär

Kombi-Abonnement

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de. Zusätzlich können Sie eine Zeitschrift Ihrer Wahl in gedruckter Form beziehen – ohne Aufpreis.

e.Med Allgemeinmedizin

Kombi-Abonnement

Mit e.Med Allgemeinmedizin erhalten Sie Zugang zu allen CME-Fortbildungen und Premium-Inhalten der allgemeinmedizinischen Zeitschriften, inklusive einer gedruckten Allgemeinmedizin-Zeitschrift Ihrer Wahl.​​​​​​​​​​​​​​

Zusatzmaterial
Authors’ original file for figure 1
13256_2013_2787_MOESM1_ESM.tif
Authors’ original file for figure 2
13256_2013_2787_MOESM2_ESM.tif
Authors’ original file for figure 3
13256_2013_2787_MOESM3_ESM.tif
Authors’ original file for figure 4
13256_2013_2787_MOESM4_ESM.tif
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2014

Journal of Medical Case Reports 1/2014 Zur Ausgabe