4D echocardiographic detection of early right atrial and ventricular dysfunction following dual-chamber pacing

Although the influence of pacing on left ventricular function is well documented, the effect of right ventricular (RV) pacing, particularly concerning lead location (septal vs. apical), on RV function remains underexplored. Furthermore, there is a lack of literature regarding right atrial (RA) remodelling and functional changes following pacemaker implantation.

To assess the effect of a dual-chamber pacemaker on RA and RV structure and function, and their correlation with the site of RV lead positioning using 4D echocardiography.

This prospective study evaluated 22 patients undergoing permanent dual-chamber pacemaker implantation. Comprehensive clinical and transthoracic echocardiographic assessments were performed at three time points: pre-implantation, pre-discharge, and at the 3-month follow-up. RV function was quantified using tricuspid annular plane systolic excursion, myocardial performance index, global longitudinal strain, and 3D RV ejection fraction. RA function was assessed for reservoir, conduit, and contractile phases using strain analysis. All echocardiographic measurements were conducted by a single echocardiographer utilizing the 4D Vivid S70N system. Device programming parameters were recorded postoperatively.

Although conventional parameters remained within the normal range, functionally, a decline in RA reservoir and conduit strain (p = 0.01 and p = 0.02, respectively) and RV GLS (p < 0.001) was observed. TR severity also worsened in nearly 40% of patients compared to baseline (p < 0.001). All patients had a pacing burden greater than 80%.

RA and RV structural and functional changes begin within 3 months, irrespective of lead site, although non-septal sites exhibited a greater impairment.