PURPOSE: The aim of this proof-of-concept study is to introduce new high-dynamic ECG technique with potential to detect temporal-spatial distribution of ventricular electrical depolarization and to assess the level of ventricular dyssynchrony. METHODS: 5-kHz 12-lead ECG data was collected. The amplitude envelopes of the QRS were computed in an ultra-high frequency band of 500-1000 Hz and were averaged (UHFQRS). UHFQRS V lead maps were compiled, and numerical descriptor identifying ventricular dyssynchrony (UHFDYS) was detected. RESULTS: An electrical UHFQRS maps describe the ventricular dyssynchrony distribution in resolution of milliseconds and correlate with strain rate results obtained by speckle tracking echocardiography. The effect of biventricular stimulation is demonstrated by the UHFQRS morphology and by the UHFDYS descriptor in selected examples. CONCLUSIONS: UHFQRS offers a new and simple technique for assessing electrical activation patterns in ventricular dyssynchrony with a temporal-spatial resolution that cannot be obtained by processing standard surface ECG. The main clinical potential of UHFQRS lies in the identification of differences in electrical activation among CRT candidates and detection of improvements in electrical synchrony in patients with biventricular pacing.

1st Department of Internal Medicine Cardioangiology St Anne's University Hospital Masaryk University Brno Czech Republic

Department of Pediatrics and Adolescent Medicine Mayo Clinic Rochester MN USA

Division of Cardiovascular Diseases Department of Internal Medicine Mayo Clinic Rochester MN USA

Institute of Scientific Instruments of the Czech Academy of Sciences Brno Czech Republic

International Clinical Research Center St Anne's University Hospital Brno Czech Republic

Student Scholar Program Mayo Clinic Rochester MN USA

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Strauss DG, Selvester RH, Wagner GS. Defining left bundle branch block in the era of cardiac resynchronization therapy. Am J Cardiol. 2011;107:927–934. doi: 10.1016/j.amjcard.2010.11.010. PubMed DOI

Surawicz B, Childers R, Deal BJ, Gettes S. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram. J Am Coll Cardiol. 2009;53:976–981. doi: 10.1016/j.jacc.2008.12.013. PubMed DOI

Ruschitzka F, Abraham WT, Singh JP, Bax JJ, Borer JS, Brugada J, Dickstein K, Ford I, Gorscan J, Gras D, Krum H, Sogaard P, Holzmeister J. Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. N Engl J Med. 2013;369(15):1395–1405. doi: 10.1056/NEJMoa1306687. PubMed DOI

Vernooy K, van Deursen CJ, Strik M, Prinzen FW. Strategies to improve cardiac resynchronization therapy. Nat Rev Cardiol. 2014;11:481–493. doi: 10.1038/nrcardio.2014.67. PubMed DOI

Lumens J, Leenders GE, Cramer MJ, De Boeck BW, Doevendans PA, Prinzen FW, Delhaas T. Mechanistic evaluation of echocardiographic dyssynchrony indices: patient data combined with multiscale computer simulations. Circ Cardiovasc Imaging. 2012;5:491–499. doi: 10.1161/CIRCIMAGING.112.973446. PubMed DOI

Asirvatham SJ. Cardiac resynchronization: is electrical synchrony relevant? J Cardiovasc Electrophysiol. 2007;18(10):1028–1031. doi: 10.1111/j.1540-8167.2007.00932.x. PubMed DOI

Muto C, Solimene F, Gallo P, Nastasi M, La Rosa C, Calvanese R, Iengo R, Canciello M, Sangiuolo R, Diemberger I, Ciardiello C, Tuccillo B. A randomized study of cardiac resynchronization therapy defibrillator versus dual-chamber implantable cardioverter-defibrillator in ischemic cardiomyopathy with narrow QRS The NARROW-CRT Study. Circ Arrhythm Electrophysiol. 2013;6:538–545. doi: 10.1161/CIRCEP.113.000135. PubMed DOI

Risum N, Tayal B, Hansen TF. Identification of Typical Left Bundle Branch Block Contraction by Strain Echocardiography Is Additive to Electrocardiography in Prediction of Long-Term Outcome After Cardiac Resynchronization Therapy. J Am Coll Cardiol. 2015;66(6):631–641. doi: 10.1016/j.jacc.2015.06.020. PubMed DOI

Schlegel TT, Kulecz WB, DePalma JL, Feiveson AH, Wilson JS, Rahman MA, Bungo MW. Real-time 12-lead high-frequency QRS electrocardiography for enhanced detection of myocardial ischemia and coronary artery disease. Mayo Clin Proc. 2004;79:339–350. doi: 10.4065/79.3.339. PubMed DOI

Goldberger AL, Bhargava V, Froelicher V, Covell J. Effect of myocardial infarction on high-frequency QRS potentials. Circulation. 1981;64:34–42. doi: 10.1161/01.CIR.64.1.34. PubMed DOI

Pettersson J, Pahlm O, Carro E, Edenbrandt L, Ringborn M, Sörnmo L, Warren SG, Wagner GS. Changes in high-frequency QRS components are more sensitive than ST-segment deviation for detecting acute coronary artery occlusion. J Am Coll Cardiol. 2000;36:1827–1834. doi: 10.1016/S0735-1097(00)00936-0. PubMed DOI

Amit G, Granot Y, Abboud S. Quantifying QRS changes during myocardial ischemia: insights from high frequency electrocardiography. J Electrocardiol. 2014;47(4):505–511. doi: 10.1016/j.jelectrocard.2014.03.006. PubMed DOI

Abboud S. High-frequency QRS electrocardiogram for diagnosing and monitoring ischemic heart disease. J Electrocardiol. 2006;39:82–86. doi: 10.1016/j.jelectrocard.2005.09.007. PubMed DOI

Plesinger F, Jurco J, Halamek J, Jurak P. SignalPlant: an open signal processing software platform. Physiol Meas. 2016; doi:10.1088/0967-3334/37/7/N38. PubMed

Plesinger F, Jurco J, Jurak P, Halamek J. Robust multichannel QRS detection. Comput Cardiol. 2014;41:557–560.

Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka A, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer M, Sutton J, Stewart W. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7:79–108. doi: 10.1016/j.euje.2005.12.014. PubMed DOI

Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt O, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. The task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC), developed in collaboration with the European heart rhythm association (EHRA) Eur Heart J. 2013;34:2281–2329. doi: 10.1093/eurheartj/eht150. PubMed DOI

Yu CM, Bleeker GB, Fung JWH, Schalij MJ, Zhang Q, van der Wall EE, Chan YS, Kong SL, Bax JJ. Left ventricular reverse remodeling but not clinical improvement predicts long-term survival after cardiac resynchronization therapy. Circulation. 2005;112:1580–1586. doi: 10.1161/CIRCULATIONAHA.105.538272. PubMed DOI

Arbelo E, Tolosana JM, Trucco E, Penela D, Borras R, Doltra A, Andreu D, Acena M, Berruezo A, Sitges M, Mansour F, Castel A, Matas M, Brugada J, Mont L. Fusion-optimized intervals (FOI): a new method to achieve the narrowest QRS for optimization of the AV and VV intervals in patients undergoing cardiac resynchronization therapy. J Cardiovasc Electrophysiol. 2014;25:283–292. doi: 10.1111/jce.12322. PubMed DOI

Stavrakis S, Lazzara R, Thadani U. The benefit of cardiac resynchronization therapy and QRS duration: a meta-analysis. J Cardiovasc Electrophysiol. 2012;23:163–168. doi: 10.1111/j.1540-8167.2011.02144.x. PubMed DOI

Sipahi I, Fang JC. FACCQRS duration criteria to select patients for cardiac resynchronization therapy CRT should be reserved for a QRS duration ≥150 ms: pro. Circ Arrhythm Electrophysiol. 2013;6:436–442. doi: 10.1161/CIRCEP.112.000160. PubMed DOI

Punn R, Hanisch D, Motonaga KS, Rosenthal DN, Ceresnak SR, Dubin AM. A pilot study assessing ECG versus ECHO Ventriculoventricular optimization in pediatric resynchronization patients. J Cardiovasc Electrophysiol. 2016;27:210–216. doi: 10.1111/jce.12863. PubMed DOI

Chung ES, Leon AR, Tavazzi L, Sun JP, Nihoyannopoulos P, Merlino J, Abraham WT, Ghio S, Leclercq C, Bax JJ, Yu CM, Gorcsan J, 3rd, St John Sutton M, De Sutter J, Murillo J. Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation. 2008;117:2608–2616. doi: 10.1161/CIRCULATIONAHA.107.743120. PubMed DOI

Leclercq C, Faris O, Tunin R, Johnson J, Kato R, Evans F, Spinelli J, Halperin H, McVeigh E, Kass DA. Systolic improvement and mechanical resynchronization does not require electrical synchrony in the dilated failing heart with left bundle-branch block. Circulation. 2002;106:1760–1763. doi: 10.1161/01.CIR.0000035037.11968.5C. PubMed DOI

Kroon W, Lumens J, Potse M, Suerder D, Klersy C, Regoli F, Murzilli R, Moccetti T. Delhaas T2, Krause R, Prinzen FW, Auricchio a. In vivo electromechanical assessment of heart failure patients with prolonged QRS duration. Heart Rhythm. 2015;12:1259–1267. doi: 10.1016/j.hrthm.2015.03.006. PubMed DOI

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