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Right ventricular (RV) pacing can be associated with impairment of left ventricular (LV) function due to electrical dyssynchrony and myocardial remodeling (Janousek et al. in J Cardiovasc Electrophysiol 15:470-474, 2004). RV-pacing induced ventricular dysfunction is reversible by techniques such as biventricular pacing and LV apical or LV free wall pacing or turning the pacemaker off which have all been shown to restore synchrony and improve left ventricular function (Janousek et al. in J Cardiovasc Electrophysiol 15:470-474, 2004; Geldorp et al. in Heart Fail Rev 16:305-314, 2011). We describe an infant with RV-pacing induced cardiomyopathy who improved when the pacing rate was reduced thus demonstrating the relationship between pacing rate and development of LV dysfunction.

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BACKGROUND Suprascapular notch is a depression located in the superior border of the scapula near its lateral part, close to the root of the coracoid process. It is bridged by the superior transverse scapular ligament & serves as a path for the suprascapular nerve. The notch is commonly seen in all the scapulae with variable morphology. Sometimes, it is associated with ossified transverse scapular ligament which plays an important role for the suprascapular neuropathies which has been suggested in many previous literatures. But, its absence can also be a reason for nerve entrapment which has been mentioned less frequently. The purpose of this study was to find out the incidence of completely absent suprascapular notch among dry scapulae of north India, especially Gurugram region along with a morphometric evaluation of superior border of scapular where the notch is situated. METHODS One hundred & ten adult dry scapulae of unknown sex from the osteology museum of SGT Medical College, Gurugram, were obtained for evaluation of absence of suprascapular notch in the superior border of the scapulae near the root of the coracoid process by subjective evaluation (visual inspection). We have also done a morphometric evaluation (length) of the superior border of all the scapulae irrespective of the suprascapular notch. Our observations were compared with other osteological studies performed on other population groups. RESULTS Of the 110 scapulae studied, 43 belonged to right side & 67 scapulae of left side. By visual inspection, 13 scapulae (11.8%) were devoid of suprascapular notch on the upper border & rest 88 scapulae (88.81%) had different variety of suprascapular notch. Among the 13 scapulae without suprascapular notch, 8 scapulae (61.5%) were of right side and 5 scapulae (38.46%) were of left sided bone. Apart from this, the average length of the superior border of the scapulae was 42.73 mm. CONCLUSIONS Incidence of completely absent suprascapular notch in our study is 11.8% which will act as a reference point among Gurugram population in north India. Clinicians should keep in mind about complete absence of suprascapular notch which can be a probable reason for the suprascapular nerve entrapment.