Pacemaker Impact on Heart Rhythm

Is Your Pacemaker Affecting Your Heart's Natural Rhythm? What You Need to Know

Lena Kashyap in Health & Wellness December 2025 • 4 min read.

"Understanding the link between right ventricular pacing and left atrial function for better heart health."

For individuals with heart rhythm irregularities, pacemakers can be a life-saving solution. These devices, typically implanted to regulate a slow heart rate, primarily use right ventricular apical (RVA) pacing to ensure consistent heartbeats. However, recent research indicates that RVA pacing, while effective, might have unforeseen consequences on the heart's overall function, particularly the left atrium (LA).

The left atrium plays a vital role in regulating blood flow and ensuring efficient heart function. When RVA pacing is used, it can disrupt the natural coordination between the heart's chambers, leading to a condition known as left ventricular (LV) dyssynchrony. This dyssynchrony can increase the risk of atrial fibrillation and other complications over time.

This article delves into the findings of a study investigating the impact of RVA pacing and its frequency on left atrial function. By understanding these effects, individuals with pacemakers and their healthcare providers can make more informed decisions about pacing strategies and long-term cardiac care.

How Does Pacemaker Placement Affect Atrial Function?

A study was conducted to investigate the impact of RVA pacing on left atrial function in patients with sick sinus syndrome (SSS). Forty patients who underwent single-chamber ventricular pacemaker implantation were monitored for 12 months. The participants were divided into two groups based on the frequency of RVA pacing: Group I, with pacing rates higher than 50%, and Group II, with pacing rates lower than 50%.

Echocardiographic evaluations, including conventional Doppler, tissue Doppler imaging, and speckle tracking strain echocardiography, were performed before and after the 12-month period to assess LV dyssynchrony and LA function.

LV Dyssynchrony: RVA pacing led to significant changes in LV dyssynchrony parameters over 12 months.
LA Function: Significant increases were observed in the LA volume index, along with reductions in peak systolic LA strain and strain rate after RVA pacing.
Correlation with Pacing Frequency: Deterioration of LA function and increased LA volume were significantly correlated with the frequency of RVA pacing. Even patients with less than 50% RVA pacing showed impaired LA strain/SR.

The findings indicated that RVA pacing, even at lower frequencies, can impair active LA contraction and passive stretching. The degree of impairment was significantly correlated with the frequency of RVA pacing, suggesting that higher pacing frequencies exacerbate the negative effects on LA function.

Making Informed Decisions About Pacemaker Therapy

The research underscores the importance of carefully considering the pacing strategy for individuals requiring pacemakers. While RVA pacing effectively manages bradycardia, its potential impact on left atrial function should not be overlooked. Regular monitoring of LV synchrony and LA function through echocardiography can help detect early signs of impairment.

For patients undergoing pacemaker implantation, discussions with cardiologists about the benefits and risks of different pacing modes are essential. Alternative pacing techniques that minimize LV dyssynchrony may be considered, especially for those at higher risk of atrial fibrillation or heart failure. Lifestyle adjustments can also help in supporting heart and overall well-being.

By staying informed and proactive, individuals with pacemakers can work with their healthcare teams to optimize cardiac function and improve long-term health outcomes.

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This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.4250/jcu.2012.20.1.42, Alternate LINK

Title: Impact Of Right Ventricular Apical Pacing And Its Frequency On Left Atrial Function

Subject: Cardiology and Cardiovascular Medicine

Journal: Journal of Cardiovascular Ultrasound

Publisher: Korean Society of Echocardiography

Authors: Byung-Joo Choi, Kyoung-Im Cho, Seong-Man Kim, Yeo-Jeong Song, Hyeon-Gook Lee, Tae-Ik Kim

Published: 2012-01-01

Everything You Need To Know

How might a pacemaker, designed to help my heart, actually affect its natural rhythm?

Pacemakers primarily use right ventricular apical (RVA) pacing to regulate heartbeats. Research suggests that RVA pacing can disrupt the natural coordination between heart chambers, potentially leading to left ventricular (LV) dyssynchrony. This dyssynchrony can increase the risk of atrial fibrillation and other complications over time. While the impact is notable, the effects can be monitored through echocardiography.

What specific effects does right ventricular apical (RVA) pacing have on the left atrium?

The study revealed that right ventricular apical (RVA) pacing can impair active left atrial (LA) contraction and passive stretching. Deterioration of left atrial function and increased left atrial volume were significantly correlated with the frequency of RVA pacing. Even patients with less than 50% RVA pacing showed impaired left atrial strain/SR.

What methods are used to monitor the impact of pacing on atrial function?

The study used echocardiographic evaluations, including conventional Doppler, tissue Doppler imaging, and speckle tracking strain echocardiography, to assess left ventricular (LV) dyssynchrony and left atrial (LA) function. These evaluations were performed before and after a 12-month period to monitor changes in heart function related to right ventricular apical (RVA) pacing.

What is left ventricular dyssynchrony, and what are its implications for heart health?

Left ventricular (LV) dyssynchrony refers to the uncoordinated contraction of the left ventricle. This dyssynchrony can arise from right ventricular apical (RVA) pacing, disrupting the natural sequence of heart contractions. The resulting uncoordinated movement can impair the heart's efficiency in pumping blood, potentially leading to heart failure or arrhythmias like atrial fibrillation. Regular monitoring can help to catch early on.

If right ventricular apical (RVA) pacing can negatively impact the left atrium, what strategies can be used to minimize these effects?

While right ventricular apical (RVA) pacing is effective for managing bradycardia, it's essential to regularly monitor left ventricular (LV) synchrony and left atrial (LA) function through echocardiography. Alternative pacing strategies, such as His-bundle pacing, may be considered to minimize the impact on left atrial function. The best option will depend on the individual’s condition and should be discussed with a cardiologist.