ArticleInternational journal of cardiology. Heart & vasculature2026
Novel dyssynchrony burden index and right ventricular function for mortality risk stratification in right ventricular apical pacing - a retrospective cohort study.
Article in International journal of cardiology. Heart & vasculature, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Right ventricular (RV) apical pacing induces electrical and mechanical dyssynchrony, potentially causing adverse remodelling and mortality. The combined prognostic effect of paced QRS duration, RV pacing burden, and RV dysfunction remains insufficiently characterized. Methods: This retrospective cohort study analyzed 180 patients with permanent pacemakers, RV apical pacing, and LVEF ≥40%. RV function was assessed by TAPSE and RV free-wall strain. A dyssynchrony burden index (standardized sum of QRS duration and pacing burden) was developed, alongside a simple 0-2 point score using clinical (QRS >150 ms, burden >40%) and Youden-optimal (>159 ms, >43%) thresholds. ROC, Kaplan-Meier, and Cox regression analyses assessed two-year all-cause mortality. Results: Twenty patients (11.1%) died. Non-survivors showed higher pacing burden, QRS duration, and impaired RV function (all Conclusions: The dyssynchrony burden index is an independent predictor of mortality in RV apical pacing; RV dysfunction adds complementary value. A simplified, bedside-calculable point-based version preserves most of this prognostic information, offering a practical risk-stratification tool.
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