Evaluation and Comparative Analysis of Global Peak Systolic Strain in Apical versus Septal Right Ventricular Pacing

Introduction: Right ventricular pacing can profoundly influence left ventricular mechanics, particularly when non‑physiological activation patterns induce mechanical dyssynchrony and impaired myocardial deformation. Global peak systolic strain is a sensitive marker for detecting pacing‑related alterations in ventricular function. This study aimed to evaluate and compare global peak systolic strain in patients undergoing right ventricular apical versus septal pacing to determine the pacing site associated with more preserved myocardial mechanics. Material and methods: This randomized historical‑control study included 60 patients undergoing permanent right ventricular pacing at a tertiary cardiac center. Participants were equally assigned to apical or septal pacing. Standardized echocardiography with speckle‑tracking analysis was performed to quantify global peak systolic strain, and outcomes were compared using appropriate statistical methods under blinded assessment and ethical approval. Results: Right ventricular pacing was associated with significant impairment of left ventricular myocardial deformation. Global longitudinal strain showed a stepwise reduction from normal subjects to septal pacing and was most severely attenuated with apical pacing (p