Evaluation and Comparison of Segmental Peak Systolic Strain in Septal and Apical Right Ventricular Pacing

Introduction: Right ventricular pacing can alter physiological ventricular activation, potentially leading to mechanical dyssynchrony and regional myocardial dysfunction. Advanced echocardiographic techniques, particularly segmental peak systolic strain analysis, allow sensitive detection of these changes. The aim of this study was to evaluate and compare segmental peak systolic strain in patients with septal versus apical right ventricular pacing. Material and methods: This randomized clinical study with a historical control design was conducted at Shahid Madani Hospital, Tabriz, between 2011 and 2013. Sixty patients requiring permanent pacing were enrolled by census sampling and allocated to septal or apical right ventricular pacing. Segmental peak systolic strain was assessed using speckle‑tracking echocardiography, with blinded analysis and appropriate statistical comparison between groups. Results: In this cohort, septal right ventricular pacing demonstrated relatively preserved and homogeneous segmental peak systolic strain compared with apical pacing. Both pacing strategies significantly reduced mid and basal septal strain compared with normal values (p0.05). In contrast, anterior septal angle and motion were significantly altered in RVA compared with RVS and normal reference values (p