Case of early right ventricular pacing lead perforation and review of the literature

Figure 1 Electrocardiogram. Electrocardiogram on the top panel taken immediately after permanent pacemaker implantation demonstrates atrial sensing with ventricular pacing (A); The electrocardiogram on the bottom panel demonstrates failure to capture in the right ventricle with underlying 2:1 atrioventricular Block (B). The pacing configuration was bipolar with high outputs. Notice the prominent pacing spikes.