Cor Vasa 2026, 68(1):16-23

Comparative study of lead placement in the right ventricular apex vs. right ventricular outflow tract: effects on left ventricular systolic dysfunction, dilatation, and myocardial performance - a single-center experience

Rerdin Jularioa, b, Ruth Irena Gunadib, Makhyan Jibril Al-Farabib, Rumman Karimahc, Budi Baktijasa Dharmadjatib, I Gde Rurus Suryawanb, Yudi Her Oktavionob
a Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Indonesia
b Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
c Faculty of Medicine and Health, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia

Aim: This study aims to analyze the difference of right ventricular (RV) apex and right ventricular outflow tract (RVOT) pacing with the incidence of left ventricular (LV) systolic dysfunction, LV dilatation, and left ventricular myocardial performance index (LVMPI) after 2 years of implantation.

Methods: This is an analytic observational study with a retrospective cohort design. The study subjects were patients using single-chamber RV pacing permanent pacemaker (PPM) after 2 years of implantation at Soetomo Surabaya General Hospital. We collected baseline characteristic data, electrocardiogram, and PPM burden. Subsequently, LVMPI, cardiac chamber dimensions, LV systolic function, left ventricular ejection fraction (LVEF) 3D, and global longitudinal strain (GLS) 3D were obtained.

Results: There was a significant decrease in all LV systolic function parameters in the post-PPM RV apical group (p = 0.003), including BIPLANE (p = 0.034), LVEF apical 2-chamber (A2C) (p = 0.029), LVEF apical 4-chamber (A4C) (p = 0.038), GLS 3D (p = 0.031), and LVEF 3D (p = 0.003). There was also significant increase in LV dilatation parameters in the RV apex group for men group only, although still within normal limits (LV end-diastolic diameter [LVEDd], p = 0.01). Finally, there was a significant decrease in the LVMPI in RV apex group (p = 0.001).

Conclusions: There is a significant difference between the implantation of PPM with RV apex pacing compared to RVOT pacing with the incidence of left ventricular (LV) systolic dysfunction, LV dilatation, and left ventricular myocardial performance index (LVMPI) after 2 years of implantation.

Keywords: Pacemaker complications, Right ventricular pacing, RV apex pacing, RVOT pacing, Single-chamber pacing

Received: March 2, 2025; Revised: March 2, 2025; Accepted: September 1, 2025; Prepublished online: June 2, 2012; Published: March 15, 2026  Show citation

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Julario R, Gunadi RI, Al-Farabi MJ, Karimah R, Dharmadjati BB, Gde Rurus Suryawan I, Her Oktaviono Y. Comparative study of lead placement in the right ventricular apex vs. right ventricular outflow tract: effects on left ventricular systolic dysfunction, dilatation, and myocardial performance - a single-center experience. Cor Vasa. 2026;68(1):16-23.
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