Impact of right ventricular lead position on left ventricular functions and early remodeling in permanent single- and dual-chamber pacemakers.

Abstract

Right ventricular (RV) apical pacing can induce both interventricular dyssynchrony and intraventricular dyssynchrony. Mechanical dyssynchrony after long-term RV apical pacing is associated with reduced left ventricular (LV) systolic function and deterioration in functional capacity. We aimed to identify the short-term effects of the pacemaker RV lead position on remodeling of LV systolic functions. The study included 30patients who presented with an indication of permanent pacing and who underwent permanent single- or dual-chamber pacemaker insertion: 15patients with RV apical pacing (RV apex), and 15patients with non-apical pacing (mid-septal). The two-dimensional (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 a3-month follow-up. At the 3‑month follow-up, post-pacing 2Dspeckle tracking echocardiography revealed impairment of global longitudinal strain in all patients and intraventricular dyssynchrony was significantly increased in the apical location compared with the non-apical location (radial dyssynchrony: 108.67 ± 11.68 ms vs. 80.53 ± 8.17 ms, p < 0.001) with a greater difference (50.53 ± 13.30 ms) in the apical location than in the non-apical location (29.87 ± 6.64 ms, p < 0.001). In the short-term follow-up, 2Dspeckle tracking echocardiography showed more radial dyssynchrony in the apical location than in the non-apical location of RV lead. The RV septal pacing is abetter alternative in terms of less dyssynchrony compared to RV apical pacing. Older age, higher percentage of pacing, and device type are prognostic factors for development of pacemaker-induced cardiomyopathy.