Long-term adverse cardiac effects of right ventricular (RV) pacing in patients with normal left ventricular (LV) ejection fraction (EF) are not well studied. The purpose of this study was to evaluate adverse effects of RV apical pacing in patients with normal LVEF. Medical records of patients who had undergone RV apical pacemaker implantation for pacing indications and had an LVEF ≥50% were reviewed to determine the effect of RV pacing burden on LV systolic and diastolic function, mechanical dyssynchrony, heart failure hospitalization (HFH), and all-cause mortality. Of the 875 eligible patients from a single center, 459 patients met the inclusion criteria, 185 had 10% LVEF (HR: 1.73 95% CI:1.09-2.75), baseline E/e' ratio (HR: 1.07 95% CI: 1.05-1.11; P < 0.0001), and LV mechanical dyssynchrony by strain imaging performed in 193 subjects (HR: 1.031 95% CI: 1.012-1.051; P < 0.001) were predictors of HFH. Baseline mechanical dyssynchrony (HR: 1.024 95% CI: 1.008-1.04; P < 0.01), its worsening by 25% (HR: 2.077 95% CI: 1.109-3.89; P < 0.03), and baseline E/e' (HR: 1.063 95% CI: 1.025-1.10; P < 0.01) were predictors of all-cause mortality. In patients with normal baseline LVEF, chronic apical RV pacing of ≥50% is associated with worse LV systolic function, LV mechanical dyssynchrony, and increases HFH.
Naqvi et al. (2025) studied this question.