Background: Right ventricular (RV) pacing can induce QRS prolongation and left ventricular dyssynchrony (LVD). The mechanical effects of different RV pacing site remain to be elucidated. Methods: Patients who underwent permanent RV pacing were prospectively enrolled for immediate postpacing echocardiography within 2 weeks after implantation. Conventional Doppler echocardiography was used to for interventricular dyssynchrony. Tissue Doppler technique was used for both inter- and intraventricular dyssynchrony. Time to peak systolic velocity (Ts) or systolic strain (Tstr) was measured in 12 LV basal and mid segments and their standard deviation were calculated (Ts-SD and Tstr-SD, respectively). Speckle tracking method was used for radial strain and LV rotation. Results: RV apical pacing was done in 22 patients (group 1) and RV septal pacing in 19 patients (group 2). Postpacing QRS duration was shorter in group 2. Indices of LVD were similar between groups, but apical rotation was significantly higher in patients with apical pacing despite similar LV ejection fraction. Conclusions: RV septal pacing did not show favorable changes in LVD, but resulted in more powerful apical rotation suggesting favorable effect on global LV contractility.