Electrical and mechanical interventricular dyssynchrony coupling in patients with bradycardia: A UHF-ECG validation trial

Jan Mizner, Ahmed Beela, Hana Linkova, Jana Vesela, Ondrej Sussenbek, Petr Stros, Radovan Smisek, Pavel Jurak, Pavel Leinveber, Jolana Lipoldova, Andrej Nagy, Petr Waldauf, Joost Lumens, Kevin Vernooy, Frits Prinzen, Karol Curila*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Ultra-high-frequency electrocardiography (UHF-ECG) is a noninvasive tool visualizing the ventricular activation sequence. It was never compared with other methods of dyssynchrony assessment in patients with bradycardia. OBJECTIVE: We aimed to compare UHF-ECG interventricular electrical dyssynchrony (e-DYS) with interventricular mechanical dyssynchrony (IVMD) measured by echocardiography in patients receiving right ventricular pacing (RVP) or conduction system pacing (CSP). METHODS: Fifty-three patients with advanced atrioventricular conduction disease and preserved ventricular systolic function were prospectively assigned to RVP (n=32) or CSP (n=21). IVMD was measured as the time difference between left ventricular and right ventricular preejection periods. Interventricular e-DYS was calculated by software as the time difference between activation in V and V chest electrodes using UHF-ECG. RESULTS: The median age of patients was 75 (interquartile range 72-80) years, and both groups had similar clinical characteristics. Baseline IVMD and interventricular e-DYS were similar in the entire population (-2 [-8 to 5] ms vs-1 [-6 to 5] ms, respectively; P=.52). Both methods showed the same dyssynchrony trends after pacemaker implantation; that is, while both IVMD and interventricular e-DYS increased in the RVP group (IVMD 28 [23-33] ms vs interventricular e-DYS 26 [19-33] ms; P=.99), they remained low in the CSP group (IVMD -7 [-16 to 2] ms vs interventricular e-DYS -5 [-12 to 2] ms; P=.91). There was a moderate overall correlation between IVMD and interventricular e-DYS for all studied ventricular rhythms (R=0.74). CONCLUSION: UHF-ECG noninvasively expresses interventricular dyssynchrony from V -V chest leads with similar results to echocardiography. RVP increases interventricular dyssynchrony, while CSP preserves synchronous ventricular activation.
Original languageEnglish
JournalHeart Rhythm
DOIs
Publication statusE-pub ahead of print - 21 Feb 2025

Keywords

  • Bradycardia
  • Conduction system pacing
  • Echocardiography
  • RV pacing
  • UHF-ECG
  • Ventricular dyssynchrony

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