This study is retrospective and prospective assessment of the prevalence ofpacing-induced cardiomyopathy clinically by symptomatology , clinicalsigns and NYHA stratification of the studied population,echocardiographically as reflected on L.V. dilatation, L.V. asymmetricalhypertroply and low exercise capacity , nuclear imaging ( radio-isotopescanning ) for assessment of LV dilatation and function and to correlatebetween the echocardiographic and nuclear findings post-pacemakerimplantation.