Ventricular pacing
Also calledVentricular pace · Ventricular paced beat · VVI pacing · VVIR pacing · RV pacing · Right ventricular pacing
Definition
Pacing delivered to the ventricle. When the lead stimulates ventricular muscle, the ECG shows a pacemaker spike followed by a broad QRS (often more than 120 ms), because activation spreads slowly from the pacing site. Right ventricular apical pacing produces a left bundle branch block pattern with a superior axis, whereas right ventricular high septal or outflow tract pacing gives an inferior axis. Successful biventricular pacing typically shows a right bundle branch block pattern (a dominant R wave) in V1, reflecting the left ventricular contribution. Conduction system pacing (His bundle or left bundle branch area pacing) recruits the heart's own conduction system and gives a narrow QRS, close to the native complex.
Clinical noteRV apical pacing gives an LBBB-like pattern with a superior axis; a dominant R wave in V1 during biventricular pacing reflects the left ventricular contribution.
Sources
- Tan K, Ng S, Foo D, et al. Physiological pacing: just a lot of buzz or the next paradigm shift in bradycardia pacing? Singapore Med J. 2026;67(2):85-89. doi.org/10.4103/singaporemedj.SMJ-2023-067
- Chung MK, Patton KK, Lau CP, et al. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. Heart Rhythm. 2023;20(9):e17-e91. doi.org/10.1016/j.hrthm.2023.03.1538
- Barold SS, Herweg B. Usefulness of the 12-lead electrocardiogram in the follow-up of patients with cardiac resynchronization devices. Part II. Cardiol J. 2011;18(6):610-624. doi.org/10.5603/cj.2011.0024
Last reviewed 2 October 2026. Every definition in the EKG Dictionary cites the guideline, consensus statement or original paper it comes from.