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A change in QRS morphology in right ventricular apical pacing: is it a red flag sign?
  1. Rakesh Jain,
  2. Sandeep Mohanan,
  3. Vellini Haridasan,
  4. Gopalan Nair Rajesh,
  5. Krishnan Mangalath Narayanan,
  6. Kalathingathodika Sajeer
  1. Department of Cardiology, Government Medical College, Kozhikode, Kerala, India
  1. Correspondence to Dr Rakesh Jain, Department of Cardiology, Government Medical College, Kozhikode 673017, Kerala, India; dr_rkjain123{at}


A 74-year-old man with symptomatic complete heart block underwent right ventricular apical permanent pacemaker implantation. The postoperative ECG showed, as expected, completely paced left bundle branch block QRS morphology. However, at the 2-month follow-up examination, his ECG showed paced right bundle branch block (RBBB) QRS morphology, although the patient was asymptomatic. On evaluation, pacemaker functioning was normal with no evidence of lead displacement. This case report highlights that RBBB morphology of paced QRS complex is not always a red flag sign.


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