Ultra-high-frequency ECG for prediction of adverse left ventricular remodeling in permanent right ventricular pacing

Over the last almost twenty years, there has been a continuous search for a method of pacing that can avoid adverse left ventricular (LV) remodeling and heart failure. Both apical and right ventricular (RV) septal pacing were found to have similar clinical outcomes, in as much as they both lead to dyssynchronous ventricular contractions. Patients exhibiting substantial ventricular dyssynchrony during pacing are at the highest risk of adverse LV remodeling. His bundle and left bundle branch pacings offer physiological ventricular activation and do not cause ventricular dyssynchrony and adverse remodeling. Dyssynchronous ventricular contractions can be detected using echocardiography, but this is not done in most patients. Ultra-high-frequency ECG (UHF-ECG) is a novel imaging method which is able to describe the pattern of ventricular activation and the time differences between activation of the heart ventricles in great detail. It is not known if UHF-ECG can be used to predict the development of adverse left ventricular remodeling in patients with RV pacing, which is the aim of this project.