Publication details

Novel ultra-high-frequency electrocardiogram tool for the description of the ventricular depolarization pattern before and during cardiac resynchronization

Authors	JURAK Pavel CURILA Karol LEINVEBER Pavel PRINZEN Frits W. VISCOR Ivo PLESINGER Filip SMISEK Radovan PROCHAZKOVA Radka OSMANCIK Pavel HALAMEK Josef MATEJKOVÁ Magdaléna LIPOLDOVÁ Jolana NOVÁK Miroslav PANOVSKÝ Roman ANDRLA Petr VONDRA Vlastimil STROS Petr VESELÁ Jana HERMAN Dalibor
Year of publication	2020
Type	Article in Periodical
Magazine / Source	JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
MU Faculty or unit	Faculty of Medicine
Citation
Web	http://dx.doi.org/10.1111/jce.14299
Doi	http://dx.doi.org/10.1111/jce.14299
Keywords	biventricular pacing; cardiac resynchronization therapy; His-bundle pacing; ultra-high-frequency ECG; ventricular electrical dyssynchrony
Description	Introduction The present study introduces a new ultra-high-frequency 14-lead electrocardiogram technique (UHF-ECG) for mapping ventricular depolarization patterns and calculation of novel dyssynchrony parameters that may improve the selection of patients and application of cardiac resynchronization therapy (CRT). Methods Components of the ECG in sixteen frequency bands within the 150 to 1000 Hz range were used to create ventricular depolarization maps. The maximum time difference between the UHF QRS complex centers of mass of leads V1 to V8 was defined as ventricular electrical dyssynchrony (e-DYS), and the duration at 50% of peak voltage amplitude in each lead was defined as the duration of local depolarization (Vd). Proof of principle measurements was performed in seven patients with left (left bundle branch block) and four patients with right bundle branch block (right bundle branch block) before and during CRT using biventricular and His-bundle pacing. Results The acquired activation maps reflect the activation sequence under the tested conditions. e-DYS decreased considerably more than QRS duration, during both biventricular pacing (-50% vs -8%) and His-bundle pacing (-77% vs -13%). While biventricular pacing slightly increased Vd, His-bundle pacing reduced Vd significantly (+11% vs -36%), indicating the contribution of the fast conduction system. Optimization of biventricular pacing by adjusting VV-interval showed a decrease of e-DYS from 102 to 36 ms with only a small Vd increase and QRS duration decrease. Conclusions The UHF-ECG technique provides novel information about electrical activation of the ventricles from a standard ECG electrode setup, potentially improving the selection of patients for CRT and application of CRT.