What type of QRS complex is associated with RV apical pacing?

When right ventricular (RV) apical pacing occurs, it often leads to a nonphysiologic, wide QRS complex on an electrocardiogram (ECG). This widening of the QRS is primarily due to the depolarization of the ventricles being altered from the normal conduction pathway. The electrical impulse bypasses the heart’s natural conduction system, which typically involves the specialized structures like the bundle of His and the Purkinje fibers, leading to asynchronous contractions of the ventricular muscle.

This asynchrony causes the ventricular depolarization to take longer than normal, manifesting as a wide QRS complex. The normal narrow QRS indicates typically synchronized conduction through the His-Purkinje system, which does not happen with RV apical pacing. Therefore, the physiological impact of pacing from the right ventricle impairs the normal conduction pattern, resulting in the characteristic wide QRS complex, which is why this is the correct answer.