Impact of right ventricle lead position on left ventricular function in permanent single and dual chamber pacemakers

Abstract

Aim and objectives: To identify the short term effect of the pacemaker RV lead position related electric remodeling on LV systolic function Patients and Methods: The study included 30 patients who presented with an indication of permanent pacing to the cardiology department of Ain Shams university hospitals and underwent permanent single or dual-chamber pacemaker insertion, 15 patients each with right ventricular (RV) apical pacing (RV apex), and 15 patients non-apical pacing (mid septal). 2D speckle tracking imaging technique was used for quantification of global longitudinal function of the left ventricle and dyssynchrony evaluation before pacemaker implantation and after a 3-month follow-up Results: 2D speckle tracking echocardiography 3 months follow up post pacing revealed impairment of global longitudinal strain in all patients and Intraventricular dyssynchrony was significantly more in apical location compared to a non-apical location (radial dyssynchrony: 108.67 ± 11.68 msec vs. 80.53 ± 8.17 msec, p-value < 0.001) with more difference (50.53 ± 13.30 msec) in apical location compared to non-apical location difference (29.87 ± 6.64 msec), p-value < 0.001.

Conclusion: By the analysis of 2D speckle tracking echocardiography, In the short-term follow-up, we found that radial dyssynchrony was more in apical location when compared to the non-apical location of RV lead. The RV septal pacing is a better alternative in terms of less dyssynchrony compared to RV apical pacing. Older age, the higher percentage of pacing, and device type are prognostic factors for the development of pacemaker-induced cardiomyopathy.