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

TL;DR

This study uses 4D echocardiography to detect early changes in right atrial and ventricular function after dual-chamber pacemaker implantation.

Contribution

The study introduces 4D echocardiography to detect early RA and RV dysfunction following dual-chamber pacing, revealing functional changes within 3 months.

Findings

RA reservoir and conduit strain decreased significantly within 3 months post-implantation.

RV global longitudinal strain declined significantly, with worsening tricuspid regurgitation in nearly 40% of patients.

Non-septal pacing sites showed greater functional impairment compared to septal sites.

Abstract

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.

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