Ventricular activation and repolarization in response to physiological and conventional pacing using ultra-high-frequency electrocardiography

Background: Physiological pacing targeting the cardiac conduction system is increasingly being adopted as an alternative to conventional right ventricular (RV) pacing for the treatment of bradyarrhythmias, although its effects on ventricular repolarization remain underexplored. Objective: This study...

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Autores: Palacios, Saúl, Smisek, Radovan, Curila, Karol, Nguyen, Uyen, Prinzen, Frits W., Halamek, Josef, Plesinger, Filip, Jurak, Pavel, Ramos, Javier, Martínez, Juan Pablo, Pueyo, Esther
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2026
País:España
Institución:Universidad de Zaragoza
Repositorio:Zaguán. Repositorio Digital de la Universidad de Zaragoza
OAI Identifier:oai:dnet:zaguan______::7797c0b1830bfcc4bba89f0c2a466a16
Acceso en línea:http://zaguan.unizar.es/record/170975
Access Level:acceso abierto
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spelling Ventricular activation and repolarization in response to physiological and conventional pacing using ultra-high-frequency electrocardiographyPalacios, SaúlSmisek, RadovanCurila, KarolNguyen, UyenPrinzen, Frits W.Halamek, JosefPlesinger, FilipJurak, PavelRamos, JavierMartínez, Juan PabloPueyo, EstherBackground: Physiological pacing targeting the cardiac conduction system is increasingly being adopted as an alternative to conventional right ventricular (RV) pacing for the treatment of bradyarrhythmias, although its effects on ventricular repolarization remain underexplored. Objective: This study evaluates depolarization and repolarization responses to different pacing techniques using ultra-high-frequency electrocardiograms (UHF-ECGs). Methods: Temporary pacing was performed at different cardiac areas in 178 patients with bradycardia. Depolarization was assessed via QRS duration (QRSd), QRS area (QRSa), ventricular dyssynchrony (e-DYS), and activation time dispersion (dAT computed from leads V1-V6 and dAT4-6 from leads V1-V6). Repolarization was analyzed using the corrected QT interval (QTc), T-wave area (Ta), Periodic Repolarization Dynamics (PRD), and repolarization time dispersion (dRTc and dRTc4-6). Results: His bundle pacing (HBP) preserved ventricular activation patterns similar to spontaneous rhythm. Left bundle branch pacing (LBBP) induced moderate depolarization changes, primarily due to delayed right ventricular activation, while maintaining left ventricular synchrony. In particular, dAT showed no significant differences between HBP and spontaneous rhythm, while differences between LBBAP and spontaneous rhythm were significant but below 7 ms in median. When restricted to the left ventricle (LV), no significant differences in dAT4-6 were found between LBBAP and spontaneous rhythm. Importantly, e-DYS for HBP showed similar values to spontaneous rhythm, LBBP led to a significant reduction (median differences approximately 20 ms), and RVP was associated with a significant increase (above 15 ms in median). In line with these results, QRSd and QRSa showed the largest values for RVP. In terms of ventricular repolarization, median differences in the QTc interval between pacing modes and spontaneous rhythm were below 3 ms for HBP, above 1 ms for LBBP, and above 20 ms for RVP. All pacing modes led to a reduction in PRD, with the most marked reductions observed for LBBP, particularly for selective LBBP, with median changes with respect to spontaneous rhythm of 4.6 degrees. RT and RTc showed similar trends for all pacing techniques. Ta, however, showed median differences with respect to spontaneous rhythm above 100 and 34 µ Vs when pacing the RV at the apex and the septum, respectively, whereas such median differences were below 16µ Vs for HBP and below 2 µ Vs for LBBP. Conclusion: Physiological stimulation via HBP or LBBAP generates ventricular depolarization and repolarization responses that more closely resembles that of spontaneous rhythm, in high contrast to the largely different response induced by RV pacing. HBP and LBBAP have distinct technical characteristics, including differences in capture thresholds, lead stability, and procedural aspects. These techniques serve as alternatives to conventional RV pacing.2026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttp://zaguan.unizar.es/record/170975reponame:Zaguán. Repositorio Digital de la Universidad de Zaragozainstname:Universidad de ZaragozaInglésinfo:eu-repo/grantAgreement/ES/DGA-FEDER/T39-23R-BSICoSinfo:eu-repo/grantAgreement/ES/DGA/LMP94_21info:eu-repo/grantAgreement/ES/MICINN/BES-2017-080587info:eu-repo/grantAgreement/ES/MICINN/PID2022-140556OB-I00info:eu-repo/grantAgreement/EUR/MICINN/TED2021-130459B-I00info:eu-repo/semantics/openAccessoai:dnet:zaguan______::7797c0b1830bfcc4bba89f0c2a466a162026-05-29T13:59:51Z
dc.title.none.fl_str_mv Ventricular activation and repolarization in response to physiological and conventional pacing using ultra-high-frequency electrocardiography
title Ventricular activation and repolarization in response to physiological and conventional pacing using ultra-high-frequency electrocardiography
spellingShingle Ventricular activation and repolarization in response to physiological and conventional pacing using ultra-high-frequency electrocardiography
Palacios, Saúl
title_short Ventricular activation and repolarization in response to physiological and conventional pacing using ultra-high-frequency electrocardiography
title_full Ventricular activation and repolarization in response to physiological and conventional pacing using ultra-high-frequency electrocardiography
title_fullStr Ventricular activation and repolarization in response to physiological and conventional pacing using ultra-high-frequency electrocardiography
title_full_unstemmed Ventricular activation and repolarization in response to physiological and conventional pacing using ultra-high-frequency electrocardiography
title_sort Ventricular activation and repolarization in response to physiological and conventional pacing using ultra-high-frequency electrocardiography
dc.creator.none.fl_str_mv Palacios, Saúl
Smisek, Radovan
Curila, Karol
Nguyen, Uyen
Prinzen, Frits W.
Halamek, Josef
Plesinger, Filip
Jurak, Pavel
Ramos, Javier
Martínez, Juan Pablo
Pueyo, Esther
author Palacios, Saúl
author_facet Palacios, Saúl
Smisek, Radovan
Curila, Karol
Nguyen, Uyen
Prinzen, Frits W.
Halamek, Josef
Plesinger, Filip
Jurak, Pavel
Ramos, Javier
Martínez, Juan Pablo
Pueyo, Esther
author_role author
author2 Smisek, Radovan
Curila, Karol
Nguyen, Uyen
Prinzen, Frits W.
Halamek, Josef
Plesinger, Filip
Jurak, Pavel
Ramos, Javier
Martínez, Juan Pablo
Pueyo, Esther
author2_role author
author
author
author
author
author
author
author
author
author
description Background: Physiological pacing targeting the cardiac conduction system is increasingly being adopted as an alternative to conventional right ventricular (RV) pacing for the treatment of bradyarrhythmias, although its effects on ventricular repolarization remain underexplored. Objective: This study evaluates depolarization and repolarization responses to different pacing techniques using ultra-high-frequency electrocardiograms (UHF-ECGs). Methods: Temporary pacing was performed at different cardiac areas in 178 patients with bradycardia. Depolarization was assessed via QRS duration (QRSd), QRS area (QRSa), ventricular dyssynchrony (e-DYS), and activation time dispersion (dAT computed from leads V1-V6 and dAT4-6 from leads V1-V6). Repolarization was analyzed using the corrected QT interval (QTc), T-wave area (Ta), Periodic Repolarization Dynamics (PRD), and repolarization time dispersion (dRTc and dRTc4-6). Results: His bundle pacing (HBP) preserved ventricular activation patterns similar to spontaneous rhythm. Left bundle branch pacing (LBBP) induced moderate depolarization changes, primarily due to delayed right ventricular activation, while maintaining left ventricular synchrony. In particular, dAT showed no significant differences between HBP and spontaneous rhythm, while differences between LBBAP and spontaneous rhythm were significant but below 7 ms in median. When restricted to the left ventricle (LV), no significant differences in dAT4-6 were found between LBBAP and spontaneous rhythm. Importantly, e-DYS for HBP showed similar values to spontaneous rhythm, LBBP led to a significant reduction (median differences approximately 20 ms), and RVP was associated with a significant increase (above 15 ms in median). In line with these results, QRSd and QRSa showed the largest values for RVP. In terms of ventricular repolarization, median differences in the QTc interval between pacing modes and spontaneous rhythm were below 3 ms for HBP, above 1 ms for LBBP, and above 20 ms for RVP. All pacing modes led to a reduction in PRD, with the most marked reductions observed for LBBP, particularly for selective LBBP, with median changes with respect to spontaneous rhythm of 4.6 degrees. RT and RTc showed similar trends for all pacing techniques. Ta, however, showed median differences with respect to spontaneous rhythm above 100 and 34 µ Vs when pacing the RV at the apex and the septum, respectively, whereas such median differences were below 16µ Vs for HBP and below 2 µ Vs for LBBP. Conclusion: Physiological stimulation via HBP or LBBAP generates ventricular depolarization and repolarization responses that more closely resembles that of spontaneous rhythm, in high contrast to the largely different response induced by RV pacing. HBP and LBBAP have distinct technical characteristics, including differences in capture thresholds, lead stability, and procedural aspects. These techniques serve as alternatives to conventional RV pacing.
publishDate 2026
dc.date.none.fl_str_mv 2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://zaguan.unizar.es/record/170975
url http://zaguan.unizar.es/record/170975
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv info:eu-repo/grantAgreement/ES/DGA-FEDER/T39-23R-BSICoS
info:eu-repo/grantAgreement/ES/DGA/LMP94_21
info:eu-repo/grantAgreement/ES/MICINN/BES-2017-080587
info:eu-repo/grantAgreement/ES/MICINN/PID2022-140556OB-I00
info:eu-repo/grantAgreement/EUR/MICINN/TED2021-130459B-I00
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv
publisher.none.fl_str_mv
dc.source.none.fl_str_mv reponame:Zaguán. Repositorio Digital de la Universidad de Zaragoza
instname:Universidad de Zaragoza
instname_str Universidad de Zaragoza
reponame_str Zaguán. Repositorio Digital de la Universidad de Zaragoza
collection Zaguán. Repositorio Digital de la Universidad de Zaragoza
repository.name.fl_str_mv
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