Key result
Dual-chamber pacemaker implantation shows no significant decline in LVEF compared to baseline.
Why the study?
Dual-chamber pacemaker implantation may cause alterations in ventricular mechanics and valvular function, but its echocardiographic effects in contemporary practice remain incompletely characterized.
Does dual-chamber pacemaker implantation alter echocardiographic parameters of ventricular and atrial function in adult patients?
Observational (n=57)
No
Does dual-chamber pacemaker implantation alter echocardiographic parameters of ventricular and atrial function in adult patients?
Mean Difference: -3.76 (95% CI -7.45–0.08)
Absolute Event Rate: 55.8% vs 59.6%
p-value: p=0.051
Dual-chamber pacemaker implantation is associated with early subclinical deterioration in right ventricular and left atrial strain despite preserved conventional systolic parameters.
Non-significant LVEF change should not alter pacing practice; leaves open the clinical relevance of associated strain deteriorations.
Background Dual-chamber pacemaker implantation restores atrioventricular synchrony, but it might be associated with alterations in ventricular mechanics and valvular function. The echocardiographic effects of dual-chamber pacing in contemporary practice remain incompletely characterized. Methods We conducted a retrospective single-center study of patients who underwent dual-chamber pacemaker implantation and had transthoracic echocardiography performed before and after implantation in 2022. Changes in left ventricular ejection fraction (LVEF), ventricular and atrial functional parameters, strain-derived measures, and tricuspid regurgitation (TR) severity were assessed using paired statistical analyses. Results In total, 57 patients were included. The mean LVEF declined from 59.6% before implantation to 55.8% after implantation (mean change, − 3.76%; 95% confidence interval [CI], − 7.45 to 0.08; P = 0.051). Among the strain-based measures, right ventricular global longitudinal strain (RVGLS) worsened by a mean of 3.10% (95% CI, 0.73 to 5.48; P = 0.012), and left atrial conduit strain (LAScd) declined by 3.74% (95% CI, 3.11 to 4.37; P = 0.032) following pacemaker implantation. Stuart-Maxwell testing showed no significant overall shift in TR severity following pacemaker implantation (χ 2 = 24.94, P = 0.678). The left atrial volume index decreased significantly (38.98 ± 17.16 mL/m 2 vs. 34.38 ± 12.65 mL/m 2 , P = 0.023), but it showed no correlation with LAScd at baseline ( ρ = − 0.183, P = 0.265) or with changes in LAScd over time ( ρ = 0.160, P = 0.350). In regression analyses, increasing age was independently associated with greater decline in LAScd (β = − 0.323 per year; 95% CI, − 0.494 to − 0.152; P < 0.001). A high pacing burden (> 20%) was not associated with changes in LVEF, LAScd, or RVGLS. Conclusions Dual-chamber pacemaker implantation was associated with early deterioration in myocardial deformation, particularly RVGLS and LAScd, despite preserved conventional systolic parameters. These functional changes were not accompanied by structural remodeling and were independent of TR progression, supporting a mechanism related to pacing-induced dyssynchrony and altered ventricular-atrial coupling. Strain imaging could offer incremental value in detecting early subclinical dysfunction in this population.
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Soh et al. (2026) conducted an observational in Bradyarrhythmias and atrioventricular conduction disease (n=57). Dual-chamber pacemaker implantation vs. Pre-implantation baseline was evaluated on Change in left ventricular ejection fraction (LVEF) (mean change -3.76%, 95% CI -7.45 to 0.08, p=0.051). Dual-chamber pacemaker implantation was associated with a non-significant mean decline in left ventricular ejection fraction of 3.76% (P=0.051) compared to baseline.
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