Right ventricular (RV) endocardial pacing in permanent pacemaker implantation usually yields a left bundle branch block (LBBB) pattern in surface electrocardiogram (ECG). The presence of right bundle branch block (RBBB) pattern raises the suspicion of lead perforation. We report a case of RV endocardial permanent pacemaker implantation showing a RBBB pattern in ECG, suggesting a complication. However, further work-up revealed that the lead was appropriately located at the RV apex.
