Objective:

To determine the incidence of pacing-induced ventricular dysfunction (PIVD) and pacing-induced cardiomyopathy (PICM) in patients with high RV pacing burden, specifically those undergoing permanent pacemaker implantation, and evaluate the predictive role of the real-time three-dimensional systolic dyssynchrony index (SDI).

Key Findings:

• PIVD affects over 30-40% of high-risk patients, while overt PICM affects approximately 10-15%, highlighting the need for improved identification methods.
• Real-time three-dimensional SDI may provide superior predictive value for identifying patients at risk of pacing-induced LV dysfunction compared to traditional metrics.

Interpretation:

The study highlights the importance of mechanical dyssynchrony assessment in predicting pacing-related LV dysfunction, suggesting that traditional electrical metrics may not be sufficient, which could influence future clinical assessments.

Limitations:

• Small sample size of 60 patients may limit generalizability.
• Short follow-up duration of 6 months may not capture long-term outcomes, and potential biases from the observational design should be considered.

Conclusion:

Real-time three-dimensional SDI could be a valuable tool in early identification of patients at risk for pacing-induced LV dysfunction, warranting further investigation to validate these findings.