Changes in Left Ventricular Global and Regional Longitudinal Strain During Right Ventricular Pacing

Background: Our study aimed to demonstrate the short-term impacts of right ventricular apical pacing (RVAP) and right ventricular septal pacing (RVSP) on left ventricular (LV) regional longitudinal strain (RLS) and global longitudinal strain (GLS) in patients with preserved ejection fraction (EF). LV strain and functions may be altered by RVAP. RVSP might be a better alternative. The detrimental effect of right ventricular (RV) pacing may be mediated by regional LV impairment. Methods: Sixty-two patients indicated for permanent pacemaker implantation and preserved LV systolic function were included. Dual chamber pacemakers were implanted in all patients. Patients were divided into two groups according to RV lead position: group A (RVAP, n = 32) and group B (RVSP, n = 30). Patients were examined at baseline and after 6 months of implantation for LV systolic functions, global and regional strain by echocardiography and 2D speckle tracking echocardiography. Results: Paced QRS duration was significantly shorter in group B compared to group A patients (P = 0.02). Regarding ventricular strain, there was no statistically significant difference between both groups at baseline measurements in comparisons of GLS, relative apical longitudinal strain (rALS) and RLS (P > 0.05). In contrast, there was statistically significant difference between both groups in results of GLS (P = 0.01) at 6 months. In addition, RLSs in septal, apical and rALS were affected after 6 months with P values of 0.02, 0.03 and 0.03, respectively. Conclusion: RVAP appears to worsen GLS more than RVSP, and the resultant decrease in apical strain is most correlated region to decrease in GLS.