Effect of Right Ventricular Apical Pacing on Right Ventricular Function: Prospective Cohort Study

Objective: There are relatively few studies on the effect of right ventricular apical pacing on right ventricular function compared to the left ventricle. Our aim was to evaluate right ventricular function after right ventricular apical pacing. Material and Methods: Fifty-five patients who underwent pacemaker implantation in a tertiary cardiology clinic were enrolled. Echocardiographic examinations, including tissue Doppler imaging and strain imaging, were performed before and 1 year after the implantation. Results: The mean age of the study population was 65.05±14.64 years, and 30 (54.5%) patients were female. Complete atrioventricular block was the primary indication for pacing in most cases (n=40, 72.7%). The majority of patients received a DDD-R pacemaker (n=45, 81.8%). When compared to pre-implantation values, we found statistically significant differences in right ventricular global longitudinal strain (-21.72±4.47% vs. -16.56±4.22%, p<0.001) and right ventricular free wall strain (-26.95±4.23% vs. -21.27±3.79%, p<0.001). Although significant decreases were also found in TAPSE, tricuspid annulus systolic velocity, and fractional area change after pacemaker implantation, these values remained within the normal range. There were no significant differences in right ventricular outflow tract diameter and left ventricular ejection fraction before and after pacemaker implantation. Conclusion: Right ventricular apical pacing leads to deterioration in right ventricular mechanical function, a finding that warrants further investigation into the long-term clinical consequences of pacing-induced right ventricular dysfunction.