Background For years, several studies have suggested permanent pacemaker implantation may cause tricuspid regurgitation due to interference with valve closure by the electrode. So, the aim of this study was to evaluate the impact of mechanical electrode on tricuspid regurgitation and right ventricular systolic pressure(RVSP) using transthoracic echocardiography(TTE). Method A retrospective analysis was performed on 80 patients(male 34%, mean age 69.1 짹 11.8 years, single lead 32.5%, mean duration of TTE after implantation 34 짹 25 months) in whom TTE was underwent before and after permanent pacemaker implantation. We compared RVSP and grade of tricuspid regurgitation(normal or trivial, mild, moderate, severe) by two dimensional and doppler echocardiography. Among 80 patients, we performed subgroup analysis of 44 patients(male 33%, mean age 68.3 짹 13.1 years, mean duration of TTE after implantation 51 짹 22 months) who underwent TTE more than 2 years after implantation. Results Grade of tricuspid regurgitation was significantly increased, but there was no significant difference in RVSP(degree of TR increased 0.34 짹 0.85, P=0.01; RVSP 34.5 짹 12.0 vs 36.6 짹 8.1, P = 0.148). However, the subgroup analysis showed significant increase in grade of tricuspid regurgitation and RVSP(degree of TR increased 0.52 짹 0.88, P < 0.001 ; RVSP 30.8 짹 9.99 vs 37.4 짹 8.42 P=0.001). On correlation analysis, we found that the longer duration of postimplantation was to increase RVSP(P = 0.011). Conclusion Echocardiogaphic long-term follow-up results after permanent pacemaker implantation showed correlation of postimplantation period with the amount of increased RVSP and increase in both grade of tricuspid regurgitation and RVSP. These results suggest that permanent pacemaker implantation can be cause of dysfunction of right heart. Keyword: Pacemaker, Tricuspid regulgitation