Ventricular activation pattern assessment during right ventricular pacing: Ultrahigh-frequency ECG study

Karol Curila*, Pavel Jurak, Josef Halamek, Frits Prinzen, Petr Waldauf, Jakub Karch, Petr Stros, Filip Plesinger, Jan Mizner, Marketa Susankova, Radka Prochazkova, Ondrej Sussenbek, Ivo Viscor, Vlastimil Vondra, Radovan Smisek, Pavel Leinveber, Pavel Osmancik

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background Right ventricular (RV) pacing causes delayed activation of remote ventricular segments. We used the ultrahigh-frequency ECG (UHF-ECG) to describe ventricular depolarization when pacing different RV locations.

Methods In 51 patients, temporary pacing was performed at the RV septum (mSp); further subclassified as right ventricular inflow tract (RVIT) and right ventricular outflow tract (RVOT) for septal inflow and outflow positions (below or above the plane of His bundle in right anterior oblique), apex, anterior lateral wall, and at the basal RV septum with nonselective His bundle or RBB capture (nsHBorRBBp). The timings of UHF-ECG electrical activations were quantified as left ventricular lateral wall delay (LVLWd; V8 activation delay) and RV lateral wall delay (RVLWd; V1 activation delay).

Results The LVLWd was shortest for nsHBorRBBp (11 ms [95% confidence interval = 5-17]), followed by the RVIT (19 ms [11-26]) and the RVOT (33 ms [27-40]; p < .01 between all of them), although the QRSd for the latter two were the same (153 ms (148-158) vs. 153 ms (148-158); p = .99). RV apical capture not only had a longer LVLWd (34 ms (26-43) compared to mSp (27 ms (20-34), p < .05), but its RVLWd (17 ms (9-25) was also the longest compared to other RV pacing sites (mean values for nsHBorRBBp, mSp, anterior and lateral wall captures being below 6 ms), p < .001 compared to each of them.

Conclusion RVIT pacing produces better ventricular synchrony compared to other RV pacing locations with myocardial capture. However, UHF-ECG ventricular dysynchrony seen during RVIT pacing is increased compared to concomitant capture of basal septal myocytes and His bundle or proximal right bundle branch.

Original languageEnglish
Pages (from-to)1385-1394
Number of pages10
JournalJournal of Cardiovascular Electrophysiology
Issue number5
Publication statusPublished - May 2021


  • conductive system
  • myocardial
  • pacing
  • ultra&#8208
  • high frequency ECG
  • ventricular dyssynchrony

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