Impact of Right Ventricle Lead Position on Left Ventricular Function in Permanent Single and Dual Chamber Pacemakers

Abstract

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 nonapical 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.