Impact of Right Ventricular Lead Position on Tricuspid Regurgitation and Right Ventricular Function Following Dual-Chamber Pacemaker Implantation: A Prospective Echocardiographic Study

Abstract

Objectives: This study aimed to evaluate the short-term impact of right ventricular apical (RVA) versus septal (RVS) lead placement on tricuspid regurgitation severity and right ventricular systolic function using conventional and speckle-tracking echocardiography. Methodology: In this prospective observational study, 100 patients undergoing dual-chamber permanent pacemaker implantation were enrolled and categorized based on RV lead position into RVA (n = 50) and RVS (n = 50) groups. Comprehensive transthoracic echocardiography, including conventional RV functional indices and right ventricular global longitudinal strain (GLS), was performed at baseline and at 3-month follow-up. TR severity was assessed using standard echocardiographic criteria. Results: Baseline clinical and echocardiographic characteristics were comparable between groups. At 3 months, the RVA group demonstrated significant right ventricular remodeling, with increased RV dimensions and right atrial enlargement. RV systolic function was significantly impaired in the RVA group, as evidenced by reduced TAPSE, RV fractional area change, and S′ velocity (all P < 0.05). Speckle-tracking analysis revealed significantly reduced RV GLS and free-wall strain in the RVA group (P ≤ 0.001). Although absolute vena contracta width did not differ significantly, a higher proportion of patients in the RVA group exhibited progression of TR severity (36.0% vs. 22.0%). Conclusion: Right ventricular apical pacing is associated with early adverse structural remodeling and deterioration of RV systolic function compared to septal pacing. Septal lead positioning may offer a more physiological alternative, potentially preserving right heart function and mitigating TR progression. Speckle-tracking echocardiography enables early detection of these subclinical changes.