An elderly man with severe chronic obstructive pulmonary disease and a history of complete heart block with pacemaker placement was found to have pacemaker lead infection and required device extraction. He had a standard dual chamber pacemaker in place, however the ECG obtained showed paced QRS complexes with presence of R wave in lead V1 and QS in lead I suggestive of left ventricular pacing. Additional imaging with CT scan obtained for confirmation revealed that the heart was displaced to the left posterior hemithorax secondary to pulmonary disease. Due to significant posterolateral rotation of the heart, a right ventricular paced rhythm can demonstrate Q/S waves in the lateral leads (I, aVL, V5–6) and R waves in the right precordial leads (V1–3). This can be misdiagnosed as a left ventricular paced rhythm.

一名患有严重慢性阻塞性肺病且有植入起搏器的完全性心脏传导阻滞病史的老年男子被发现患有起搏器导线感染，需要拔除装置。他安装了标准双腔起搏器，但心电图显示起搏 QRS 复合波，V1 导联存在 R 波，I 导联存在 QS，提示左心室起搏。为进一步确认而获得的 CT 扫描影像显示，由于肺部疾病，心脏移位至左后半胸。由于心脏显着的后外侧旋转，右心室起搏节律可以在侧导联（I、aVL、V5-6）中显示 Q/S 波，在右心前导联（V1-3）中显示 R 波。这可能会被误诊为左心室起搏心律。