Background
Left ventricular (LV) dysfunction is known to occur after right ventricular (RV) pacing;
the effect on RV function is less well studied. The aim of this study was to assess
the impact of RV mid-septal pacing upon RV function using the novel parameters of
speckle-tracking derived RV global longitudinal strain (RV GLS) and RV free wall strain
(RV FWS), as well as the conventional parameters RV fractional area change (FAC),
tricuspid annular plane systolic excursion (TAPSE), and tricuspid annular systolic
velocity (RV S').
Methods
Thirty-two (32) consecutive patients with normal baseline LV and RV function requiring
permanent pacemaker insertion (for high-grade AV block or sinus node dysfunction)
were prospectively recruited. Echocardiography was performed prior to implantation,
at 1 day, 1 month and 1 year after implantation, with 29 patients completing follow-up.
Results
After 1 year, three patients (10%) with otherwise normal RV parameters developed abnormal
RV strain patterns. Compared to 1 day after implantation, at 1 year significant reductions
were observed in mean RV GLS (-24.8 to -21.8%) RV S' (15.1 to 12.2 cm/s), TAPSE (24.2
to 21.9 mm), RV GLS (-24.8 to -21.8%), left ventricular ejection fraction (LVEF) (66.0
to 57.9%), LV GLS (-19.9 to 17.0), all p<0.01. There was a non-significant reduction
for RV FWS (-29.0 to -26.7%, p=0.06) and there was no change in RV FAC (49.1 to 46.9%,
p=0.24).
Conclusion
We report abnormalities of RV strain developing 1 year after pacemaker insertion.
Measurement of myocardial strain is emerging as an additional method to detect patients
at risk of RV dysfunction in those who have undergone pacemaker implantation.
Keywords
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Article info
Publication history
Published online: December 20, 2022
Accepted:
November 3,
2022
Received in revised form:
September 8,
2022
Received:
June 5,
2022
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
