Acute right systolic ventricular dysfunction in permanent cardiac pacing. Insight from RV PACE trial (Right Ventricular function assessment in Permanent cArdiac paCing by Echography)

Abstract

Permanent right ventricular (RV) pacing is now clearly linked to heart failure and decrease in LVEF, in non neglected proportion. Several trials and observations reported the worse impact of this heart pacing mode on left ventricular functions, but rare are those that studied RV systolic function. In this observational prospective trial, we evaluate echographic systolic RV function, before and immediately after cardiovascular implantable electronic device (CIED) implantation and at 6 months of follow-up. In this intermediate analysis, we report impact of RV pacing on systolic RV function. Between February 2020 and February 2021, we enrolled 174 [114 (65%) male, 38 (21%) with AF] consecutive patients underwent RV permanent pacing (CRT, Hisian and left bundle branch pacing excluded) in prospective study for evaluation of echographic parameters of RV systolic function (TAPSE, RV S’, RV global longitudinal strain and RV free wall strain) and severity of tricuspid regurgitation (TR). Transthoracic echography (TTE) was performed (by 3 physicians) at baseline (just before procedure) and immediately after implantation. At baseline, mean LVEF was 56% ± 15.6. TAPSE (22.8 ± 6.29 vs. 19.3 ± 5.47 mm; P < 0.001) and tissue Doppler on lateral tricuspid annular (RV S’) (12.1 ± 3.28 vs. 11.2 ± 3.28 cm/s; P < 0.001) measured before and immediately after implantation show a significant decrease in RV function. The same finding is reported for Global RV Strain (−20 ± 0.6 vs. −18 ± 0.5%; P < 0.001) and RV free wall strain (−25 ± 0.7 vs. −23 ± 0.6%; P < 0.001). TR after CEID implantation is more severe in comparison with basal echography [TR stage 1/2: 132 (89%) vs. 110 (79%); P < 0.01] (Fig. 1). Permanent RV pacing immediately decrease RV systolic function assessed traditional echocardiographic parameters and RV strain. TR also gets worsened.