Around one million pacemakers are installed every year, with atrio-ventricular (AV) block being the reason for more than a third of these procedures. High-burden right ventricular (RV) pacing is often tolerated for decades without any overt left ventricular (LV) failure in the majority of patients. It has been shown, however, that prolonged RV pacing reduces LV function and ultimately causes heart failure. Left ventricular ejection fraction (LVEF) may decrease in certain individuals with pacemaker implants following pacing. Pacing-induced cardiomyopathy (PICM) is the medical term for this issue. However, pacing-induced LV dysfunction (PIVD) at milder severity levels has also been documented. Predicting PICM and PIVD one year after pacemaker installation is made possible by measuring global longitudinal strain (GLS) one month after implantation.