A higher RVP burden may indicate early deterioration in ventricular performance. A longitudinal cohort analysis published in Heart Rhythm evaluated how progressive changes in RVP percentage (RVP%) relate to mechanical and arrhythmic consequences over extended follow-up.

The study included 148 individuals who underwent RVP implantation between 2013 and 2024 and had at least six months of follow-up with serial RVP% measurements. An annual pacing increase of 10% or greater defined the Elevation group. Primary outcomes included changes in left ventricular ejection fraction (LVEF) and left ventricular end-diastolic dimension (LVDd). Secondary outcomes assessed the development of ventricular tachyarrhythmia (VT/VF), atrial fibrillation (AF), and heart failure hospitalization (HFH).

Over a median follow-up duration of 1825 days, individuals in the Elevation group experienced a steeper decline in LVEF (–3.33%/year vs –1.81%/year, p=0.028) and progressive enlargement of LVDd (+1.19 mm/year vs –0.19 mm/year, p<0.001) compared with the Stable group. VT/VF risk was significantly higher (HR 6.48; 95% CI 3.44–12.2; p<0.001) and HFH was more frequent (adjusted HR 3.41; 95% CI 1.42–8.20; p=0.006). No significant association appeared for AF (p=0.33).

These findings indicate that increasing RVP% may serve as an early clinical risk marker for LV remodeling and ventricular arrhythmias. Routine monitoring of pacing trends may help identify individuals who require closer surveillance or optimization of pacing strategy.