Right Ventricular Function Changes After CIED Implantation: The RIGHT-CIED Study

Inclusion Criteria * Adults aged 18 years or older. * Scheduled to undergo implantation of a clinically indicated pacemaker, ICD, or CRT device. * Able to undergo transthoracic echocardiography, VEXUS ultrasound assessment, and non-contrast cardiac MRI. * Able to provide written informed consent. Exclusion Criteria * Contraindication to cardiac MRI (e.g., severe claustrophobia or MRI-unsafe implanted material). * Inability to undergo echocardiography or ultrasound assessment. * Known pulmonary arterial hypertension (Group 1 PH). * Significant congenital heart disease. * Patients with mechanical or bioprosthetic heart valve replacement * Severe left-sided valvular disease (severe AS or severe MR). * Chronic kidney disease stage 4 or 5 (eGFR \< 30 mL/min/1.73m²). * End-stage renal disease requiring dialysis. * Primary hyperparathyroidism. * Hypophosphataemia or hyperphosphataemia requiring treatment. * Active or uncontrolled bone metabolism disorders (e.g., osteomalacia, Paget's disease). * Recent fracture or major orthopaedic surgery within the past 3 months. * Active systemic inflammatory or autoimmune disease. * Active malignancy or malignancy requiring ongoing treatment. * Active infection at the time of enrolment. * Pregnancy or breastfeeding. * Haemodynamic instability at the time of enrolment. * Expected survival less than 6 months due to non-cardiac conditions. * Inability to provide informed consent.