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Paced QRS morphology mimicking complete left bundle branch block induced by right ventricular pacing is associated with pacing?induced cardiomyopathy

Journal of Cardiovascular Electrophysiology

Complete left bundle branch block (CLBBB)-like QRS morphology of right ventricular pacing at pacemaker implantation satisfying the American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society criteria of CLBBB was associated with development of pacing induced cardiomyopathy.

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Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

PVCs N ot generally considered abnormal ECG findings: Isolated PAC, First Degree AV Block, Sinus bradycardia at a rate of 35-45, and Nonspecific ST-T abnormalities (even if different from a previous ECG). Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful.

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Syncope and a short pause on event monitor

Dr. Smith's ECG Blog

If the block is not vagal in nature, the patient should receive a pacemaker. There was a randomized trial to determine whether pacemakers could benefit patients with vasovagal syncope, aptly named The North American Vasovagal Pacemaker Study (VPS). In the repeat study (VPS II), EVERY patient had an implanted pacemaker.