Impact of Right Ventricular Pacing Sites on Right Ventricular Function: Systematic Review and Meta-analysis

Area of Science:

• Cardiology and Cardiovascular Research
• Medical Device Technology
• Echocardiography and Cardiac Imaging

Background:

• Conventional dual-chamber pacemakers can negatively affect the left ventricle, leading to pacing-induced cardiomyopathy.
• The impact of right ventricular (RV) pacing on RV remodeling and function remains less understood compared to its effects on left ventricular function.

Purpose of the Study:

• To systematically review and meta-analyze the effects of RV pacing on various right ventricular echocardiographic parameters.
• To investigate the influence of pacing site and duration on RV function following RV pacing.

Main Methods:

• Systematic review and meta-analysis conducted following PRISMA guidelines.
• Searched Embase, PubMed, and SCOPUS databases from inception to March 2024.
• Included 18 studies (1,220 patients) analyzing RV ejection fraction (RVEF), pulmonary artery systolic pressure (sPAP), tricuspid annular plane systolic excursion (TAPSE), RV index of myocardial performance (RIMP), and tricuspid lateral annular systolic velocity (S').

Main Results:

• RV pacing showed a significant reduction in S' (pooled mean difference -1.3522 cm/s, p=0.0089).
• No significant changes were observed in RVEF, TAPSE, RIMP, 2D fractional area change (FAC), or sPAP.
• Pacing site significantly affected TAPSE, S', FAC, and sPAP, with apical pacing demonstrating the most detrimental effects and LBBAP showing better outcomes.

Conclusions:

• RV pacing is associated with significant reductions in S' and other echocardiographic parameters, with pacing site being a major driver of heterogeneity.
• Apical pacing resulted in the most adverse effects on RV function, whereas LBBAP was linked to more favorable outcomes.
• Further research is warranted to explore residual heterogeneity and additional influencing factors.