It paces right but not in the right space

A 77-year-old woman with a clinical history of diabetes mellitus, hypertension, dyslipidaemia, symptomatic sinus node dysfunction, and a dual-chamber permanent pacemaker implanted in June 2011 was referred to our hospital for a routine clinical check-up. The electrocardiogram (EKG) showed right bundle branch block (RBBB) pattern during dual chamber pacing ( Panel A …