A 60-year-old male with heart failure and severely reduced left ventricular function was scheduled for elective implantation of a cardiac resynchronisation therapy defibrillator device. Coronary artery angiography revealed no significant coronary artery disease. He remained symptomatic despite guideline-directed optimal medical therapy. The ambulatory electrocardiogram (ECG) showed sinus rhythm with a slightly prolonged PR interval, ventricular ectopic beats and complete left bundle branch block (LBBB) with QRS duration ~150 ms and mid-QRS notching in > 2 leads, consistent with the Strauss criteria for LBBB (Fig. 1; [1]). The device implantation was successful, and there were no procedural complications. A postoperative ECG was obtained on the cardiology ward shortly after the procedure (Fig. 2).
Fig. 1
Preoperative electrocardiogram
Fig. 2
Postoperative electrocardiogram
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What type of pacing can be seen, and what other distinctive pathology is revealed?
Answer
You will find the answer elsewhere in this issue.
Conflict of interest
S.A.J. Timmer is consultant for Medtronic. T. Germans declares that he has no competing interests.
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