UHF-ECG Clinical Evidence

Scientific publications and clinical benefit evidence for ultra-high-frequency ECG in conduction system pacing and cardiac resynchronization therapy.

Main Publications−
  1. Curila, K., Mizner, J., Morava, J., Smisek, R., Vesela, J., Sussenbek, O., Stros, P., Kupec, J., Waldauf, P., Leinveber, P., Poviser, L., Nagy, L., Cerny, J., Bitmanova, B., Jurak, P., & Polasek, R. (2025). Prospective randomized trial of conduction system pacing vs right ventricular pacing for patients with atrioventricular block; Prague CSP trial. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2025.05.036
  2. Mizner, J., Beela, A., Linkova, H., Vesela, J., Sussenbek, O., Stros, P., Smisek, R., Jurak, P., Leinveber, P., Lipoldova, J., Nagy, A., Waldauf, P., Lumens, J., Vernooy, K., Prinzen, F., & Curila, K. (2025). Electrical and mechanical interventricular dyssynchrony coupling in patients with bradycardia: A UHF-ECG validation trial. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2025.02.031
  3. Moraleda-Salas, M. T., Amigo-Otero, E., Esteve-Ruiz, I., Arce-León, Á., Carreño-Lineros, J. M., Izaga Torralba, E., Navarro Roldan, F., & Moriña-Vázquez, P. (2024). Early improvement in cardiac function and dyssynchrony after physiological upgrading in pacing-induced cardiomyopathy. Pacing and Clinical Electrophysiology. https://doi.org/10.1111/pace.15126
  4. Verstappen, A. A. A., Hautvast, R., Jurak, P., Bracke, F. A., & Rademakers, L. M. (2024). Ventricular dyssynchrony imaging, echocardiographic and clinical outcomes of left bundle branch pacing and biventricular pacing. Indian Pacing and Electrophysiology Journal, 24(3), 140-146. https://doi.org/10.1016/j.ipej.2024.04.007
  5. Curila, K, Poviser, L, Stros, P. et al. LVSP and LBBP Result in Similar or Improved LV Synchrony and Hemodynamics Compared to BVP. J Am Coll Cardiol EP. 2024 Jul, 10 (7_Part_2) 1722–1732.
    https://www.jacc.org/action/showCitFormats?doi=10.1016/j.jacep.2024.04.022
  6. Nguyên U.C, Rijks J.H.J, Plesinger F, et al. Ultra-High-Frequency ECG in Cardiac Pacing and Cardiac Resynchronization Therapy: From Technical Concept to Clinical Application. J. Cardiovasc. Dev. Dis. 2024, 11(3), 76. doi.org/10.3390/jcdd11030076.https://www.mdpi.com/2308-3425/11/3/76
  7. Curila, K., Jurak, P., & Varma, N. (2023). Resynchronization for shifting conduction patterns - When a coronary sinus lead is not enough. Indian Pacing and Electrophysiology Journal, 23(6), 214-215. https://doi.org/10.1016/j.ipej.2023.08.005
  8. Sussenbek, O., Rademakers, L., Waldauf, P., Jurak, P., Smisek, R., Stros, P., Poviser, L., Vesela, J., Plesinger, F., Halamek, J., Leinveber, P., Herman, D., Osmancik, P., & Curila, K. (2023). Left bundle branch area pacing results in more physiological ventricular activation than biventricular pacing in patients with left bundle branch block heart failure. European Heart Journal Supplements, 25(Suppl E), E17-E24. https://doi.org/10.1093/eurheartjsupp/suad109
  9. Leinveber P, Halamek J, Curila K et al. Ultra-high-frequency ECG volumetric and negative derivative epicardial ventricular electrical activation pattern. Sci Rep 14, 5681 (2024). doi.org/10.1038/s41598-024-55789-w
    https://www.nature.com/articles/s41598-024-55789-w
  10. Curila K, Jurak P, Prinzen F.,et al. Bipolar anodal septal pacing with direct LBB capture preserves physiological Ventricular activation better than unipolar left bundle branch pacing. Front.Cardiovasc. Med.,22 March 2023.
    https://www.frontiersin.org/articles/10.3389/fcvm.2023.1140988/full
  11. Mizner J, Jurak P, Linkova H, Smisek R, Curila K. Ventricular dyssynchrony and pacing-induced cardiomyopathy in patients with pacemakers, the utility of ultra-high-frequency ECG and other dyssynchrony assessment tools. Arrhythmia &Electrophysiology Review. 2022;11. doi:10.15420/aer.2022.01
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9376832/
  12. Jurak P, Bear L, Nguyên U, et al. 3-Dimensional Ventricular Electrical Activation Pattern Assessed from A Novel High-Frequency Electrocardiographic Imaging Technique: Principles and Clinical Importance. Scientific Reports. 11. 2021
    https://www.nature.com/articles/s41598-021-90963-4
  13. Curila K, Jurak P, Jastrzebski M, et al. Left bundle branch pacing compared to left ventricular septal myocardial pacing increases interventricular dyssynchrony but accelerates left ventricular lateral wall depolarization. Heart Rhythm. 2021;18(8):1281-1289. doi:10.1016/j.hrthm.2021.04.025
    https://www.heartrhythmjournal.com/article/S1547-5271(21)00402-1/pdf
  14. Curila K, Jurak P, Halamek J, et al. Ventricular Activation Pattern Assessment during Right Ventricular Pacing; Ultra-High-Frequency ECG Study. Journal of Cardiovascular Electrophysiology. 2021. https://onlinelibrary.wiley.com/doi/full/10.1111/jce.14985
  15. Curila K, Prochazkova R, Jurak P, et al. Both selective and nonselective His bundle, but not myocardial, pacing preserve ventricular electrical synchrony assessed by ultra-high-frequency ECG. Heart Rhythm. 2020;17(4):607-614. doi:10.1016/j.hrthm.2019.11.016
    https://www.heartrhythmjournal.com/article/S1547-5271(19)31028-8/pdf
  16. Jurak P, Curila K, LeinveberP, et al. Novel ultra‐high‐frequency electrocardiogram tool for the description of the ventricular depolarization pattern before and during cardiac resynchronization.Journal of Cardiovascular Electrophysiology.2019;31(1):300-307. doi:10.1111/jce.14299
    https://onlinelibrary.wiley.com/doi/full/10.1111/jce.14299
  17. Plesinger F, Jurak P, HalamekJ, et al. Ventricular Electrical Delay Measured From Body Surface ECGs Is Associated With Cardiac Resynchronization Therapy Response in Left Bundle Branch Block Patients From the MADIT-CRT Trial (Multicenter Automatic Defibrillator Implantation-Cardiac Resynchronization Therapy).Circulation:Arrhythmia and Electrophysiology.2018;11(5). doi:10.1161/circep.117.005719
    https://www.ahajournals.org/doi/full/10.1161/CIRCEP.117.005719
  18. Jurak P, Halamek J, Meluzin J, et al. Ventricular dyssynchrony assessment using ultra-high frequency ECG technique. Journal of Interventional Cardiac Electrophysiology. 2017;49(3):245-254. doi:10.1007/s10840-017-0268-0 https://link.springer.com/article/10.1007/s10840-017-0268-0
Other Publications+
  1. Prinzen FW, Jurak P, Leinveber P, Plesinger F, Curila K, Halamek J. Comparison of UHF-ECG with other noninvasive electrophysiological mapping tools for assessing ventricular dyssynchrony. In: 2021 Computing in Cardiology (CinC). IEEE; 2021. http://dx.doi.org/10.23919/cinc53138.2021.9662706
  2. Curila K, Jurak P, Leinveber P, et al. Physiological versus non-physiological cardiac pacing as assessed by Ultra-high-frequency electrocardiography. In: 2021 Computing in Cardiology (CinC). IEEE; 2021. http://dx.doi.org/10.23919/cinc53138.2021.9662912
  3. Plesinger F, Viscor I, Vondra V, et al. VDI Vision - Analysis of Ventricular Electrical Dyssynchrony in Real-Time. In: 2021 Computing in Cardiology (CinC). IEEE; 2021. http://dx.doi.org/10.23919/cinc53138.2021.9662916
  4. Koscova Z, Ivora A, Nejedly P, et al. QRS Complex Detection in Paced and Spontaneous Ultra-High-Frequency ECG. In: 2021 Computing in Cardiology (CinC). IEEE; 2021. http://dx.doi.org/10.23919/cinc53138.2021.9662647
  5. Jurak P, Leinveber P, Plesinger F, et al. Ultra-High-Frequency Electrocardiography. In: 2021 Computing in Cardiology (CinC). IEEE; 2021. http://dx.doi.org/10.23919/cinc53138.2021.9662795
  6. Leinveber P, Halamek J, Jurak P, et al. The Ultra-High-Frequency QRS Dyssynchrony in the Assessment of Cardiac Resynchronization Therapy Effect. In: 2019 Computing in Cardiology Conference (CinC). 2019. http://dx.doi.org/10.22489/cinc.2019.368
  7. Matejkova M, Lipoldova J, Leinveber P, et al. Optimized CRT Stimulation Based on Ultra-High-Frequency QRS Analysis. In: 2019 Computing in Cardiology Conference (CinC). 2019. http://dx.doi.org/10.22489/cinc.2019.071
  8. Halamek J, Leinveber P, Viscor I, et al. Cardiac Resynchronization Guided by Ultra-High-Frequency ECG Maps. In: 2019 Computing in Cardiology Conference (CinC). 2019. http://dx.doi.org/10.22489/cinc.2019.246
  9. Halamek J, Leinveber P, Viscor I, et al. The relationship between ECG predictors of cardiac resynchronization therapy benefit. PLOS ONE.2019;14(5):e0217097. doi:10.1371/journal.pone.0217097
  10. Halamek J, Leinveber P, Malik M, et al. High-Frequency QRS Analysis From Orthogonal Leads. In: 2018 Computing in Cardiology (CinC). 2018. http://dx.doi.org/10.22489/cinc.2018.051
  11. Andrla P, Leinveber P, Châu Nguyên U, et al. Body-Surface Mapping Using High-Frequency ECG to Characterize Electrical Activation Delay. In: 2018 Computing in Cardiology. 2018. http://dx.doi.org/10.22489/cinc.2018.105
  12. Jurak P, Châu Nguyên U, Viscor I, et al. Epicardial Isochrones from a New High-Frequency ECG Imaging Technique. In: 2018 Computing in Cardiology (CinC). 2018. http://dx.doi.org/10.22489/cinc.2018.088
  13. Plesinger F, Jurak P, Halamek J, Leinveber P, Viscor I, Jurak P. A Method for Removing Pacing Artifacts From Ultra-High-Frequency Electrocardiograms. In: 2018 Computing in Cardiology (CinC). 2018. http://dx.doi.org/10.22489/cinc.2018.339
  14. Andrla P, Plesinger F, Halamek J, Leinveber P, Viscor I, Jurak P. A Method for Removing Pacing Artifacts From Ultra-High-Frequency Electrocardiograms. In: 2018 Computing in Cardiology (CinC). 2018. http://dx.doi.org/10.22489/cinc.2018.106
  15. Halamek J, Leinveber P, Plesinger F, Matejkova M, Jurak P. Attenuation of QRS Power in the Frequency Range from 0.05 to 1 kHz. In: Computing in Cardiology (CinC). 2017. http://dx.doi.org/10.22489/cinc.2017.096-110
  16. Plesinger F, Jurak P, Halamek J, et al. The VED Meter - a New Tool to Measure the Ventricular Conduction Abnormalities in Heart Failure Patients. In: Computing in Cardiology (CinC). 2017. http://dx.doi.org/10.22489/cinc.2017.377-059
  17. Leinveber P, Halamek J, Jurak P. Ambulatory monitoring of myocardial ischemia in the 21st century—an opportunity for high-frequency QRS analysis. Journal of Electrocardiology. 2016;49(6):902-906. doi:10.1016/j.jelectrocard.2016.07.034
  18. Jurak P, Leinveber P, Halamek J, et al. Biventricular Pacing Optimization by Means of the Dyssynchrony Parameter. In: 2016Computing in Cardiology (CinC). 2016. http://dx.doi.org/10.22489/cinc.2016.051-263
  19. Reichlova T, Jurak P, Halamek J, et al. Cardiac resynchronization efficiency estimation by new ultra-high-frequency ECG dyssynchrony descriptor. In: 2015 Computing in Cardiology (CinC). IEEE; 2015. http://dx.doi.org/10.1109/cic.2015.7410964
  20. Jurak P, Halamek J, Plesinger F, et al. An additional marker of ventricular dyssynchrony. In: 2015 Computing in Cardiology (CinC). IEEE; 2015. http://dx.doi.org/10.1109/cic.2015.7408590
  21. Plesinger F, Jurco J, Halamek J, Leinveber P, Reichlova T, Jurak P. Multichannel QRS Morphology Clustering - Data Preprocessing for Ultra-High-Frequency ECG Analysis. In: Proceedingsof the 3rd International Congress on Cardiovascular Technologies.SCITEPRESS - Science and and Technology Publications; 2015. http://dx.doi.org/10.5220/0005604200110019
  22. Jurak P, Halamek J, Leinveber P, et al. Time-frequency interpretation of ultra-high-frequency QRS components. In: 20148th Conference of the European Study Group on Cardiovascular Oscillations (ESGCO).IEEE; 2014. http://dx.doi.org/10.1109/esgco.2014.6847526
  23. Jurak P, Halamek J, Leinveber P, Vondra V, Soukup L, Vesely P, Sumbera J, Zeman K, Martinakova L, Jurakova T, Novak M. Ultra-high-frequency ECG measurement. In: 2013, Computing in Cardiology (CinC). IEEE; 2013 http://cinc.mit.edu/archives/2013/pdf/0783.pdf
Clinical Evidence and Benefit+

From Clinical Evidence to Clinical Benefit

Explore the evidence map directly on the website. Switch between CSP and CRT, then use the category buttons to focus the table on publication type, main publications, or high-impact evidence.

CSP evidence map

BenefitCategoryPatientsPublicationAuthor / Journal
Lead progression through the septum and decision when to stopClear RVSP, Deep, LVSP, LBBAP patternsOR57Left Ventricular Myocardial Septal Pacing in Close Proximity to LBB Does Not Prolong the Duration of the Left Ventricular Lateral Wall Depolarization Compared to LBB PacingCurila et al., Frontiers in Cardiovascular Medicine, 2021
RVSP, Deep, LBBAP patternsClear RVSP, Deep, LVSP, LBBP patterns★OR75Bipolar anodal septal pacing with direct LBB capture preserves physiological ventricular activation better than unipolar left bundle branch pacingCurila et al., Frontiers in Cardiovascular Medicine, 2023
RVSP, Deep, LBBAP patternsClear RVSP, Deep, LVSP, LBBP patterns★RV-Ventricular Dyssynchrony and Pacing-induced Cardiomyopathy in Patients with Pacemakers, the Utility of Ultra-high-frequency ECG and Other Dyssynchrony Assessment ToolsMizner et al., Arrhythmia and Electrophysiology Review, 2022
RVSP, Deep, LBBAP patternsClear RVSP, Deep, LVSP, LBBP patterns★OR249Prospective Randomized Trial of Conduction System Pacing versus Right Ventricular Pacing for Patients with Atrio-Ventricular BlockCurila et al., Heart Rhythm Society, 2025
RVSP, Deep, LBBAP patternsClear RVSP, Deep, LVSP, LBBP patterns!OR-European Society of Cardiology (ESC) clinical consensus statement on indications for conduction system pacingGlikson et al., EP Europace, 2025
RVSP, Deep, LBBAP patternsClear RVSP, Deep, LVSP, LBBP patternsCR2Ultra-high-frequency ECG quantifies divergent electrical phenotypes after left bundle branch area pacing: Resynchronization in baseline LBBB versus preservation of synchrony in baseline narrow QRSYessenov et al., Journal of Electrocardiology, 2026
RVSP, Deep, LBBAP patternsClear RVSP, Deep, LVSP, LBBP patternsOR55Left ventricular septal and non-selective left bundle branch pacing reduce right ventricular and interventricular dyssynchrony in patients with right bundle branch blockPoviser et al., Journal of Interventional Cardiac Electrophysiology, 2026
RVSP, Deep, LBBAP patternsClear RVSP, Deep, LVSP, LBBP patterns★OR27Early Improvement in Cardiac Function and Dyssynchrony After Physiological Upgrading in Pacing-Induced CardiomyopathyMoraleda-Salas et al., PACE, 2024
LBBB vs IVCD phenotypizationAB125Invasive Validation of a Novel Method for Characterizing Left Ventricular Conduction Block in Candidates for Cardiac Resynchronization TherapyZhao et al., HRS, 2026
Differentiation between LVSP and LBBP★OR68Left bundle branch pacing compared to left ventricular septal myocardial pacing increases interventricular dyssynchrony but accelerates left ventricular lateral wall depolarizationCurila et al., Heart Rhythm Society, 2021
HIS bundle pacing pattern★OR46Both selective and nonselective His bundle, but not myocardial, pacing preserve ventricular electrical synchrony assessed by ultra-high-frequency ECGCurila et al., Heart Rhythm Society, 2020
Gross RV malpositions★OR51Ventricular activation pattern assessment during right ventricular pacing: Ultra-high-frequency ECG studyCurila et al., Journal of Cardiovascular Electrophysiology, 2021

CRT evidence map

BenefitCategoryPatientsPublicationAuthor / Journal
Selection of CRT respondersUHF-ECG identifies patients with and without dyssynchrony before CRT★!OR949Ventricular Electrical Delay Measured From Body Surface ECGs Is Associated With Cardiac Resynchronization Therapy Response LBBB Patients From the MADIT-CRT TrialPlesinger et al., Circulation: Arrhythmia and Electrophysiology, 2018
Selection of CRT respondersUHF-ECG identifies patients with and without dyssynchrony before CRTOR57Left Ventricular Myocardial Septal Pacing in Close Proximity to LBB Does Not Prolong the Duration of the Left Ventricular Lateral Wall Depolarization Compared to LBB PacingCurila et al., Frontiers in Cardiovascular Medicine, 2021
Selection of CRT respondersUHF-ECG identifies patients with and without dyssynchrony before CRT★!OR80Left bundle branch area pacing results in more physiological ventricular activation than biventricular pacing in patients with left bundle branch block heart failureSussenbek et al., European Heart Journal, 2023
Selection of CRT respondersUHF-ECG identifies patients with and without dyssynchrony before CRTAB92Ventricular dyssynchrony assessed by ultra-high-frequency electrocardiography predicts the response to biventricular cardiac resynchronization therapyLeinveber et al., HRS 2023
Selection of CRT respondersUHF-ECG identifies patients with and without dyssynchrony before CRTPR48A novel approach for LV delay evaluation: non-invasive QLV measurement using UHF-ECGPoviser et al., medRxiv, 2025
Selection of CRT respondersUHF-ECG identifies patients with and without dyssynchrony before CRT!OR21Left ventricular subendocardial pacing provides the same left ventricular synchrony and work efficiency as direct left bundle branch capturePoviser et al., Heart Rhythm, 2025
Selection of CRT respondersUHF-ECG identifies patients with and without dyssynchrony before CRTAB345Sex-specific differences in ventricular dyssynchrony at comparable QRS duration: insights from Ultra-High-Frequency ECGKlein et al., EHRA 2026
Type of CRT stratificationsCSP, Lot-CRT, BiV-CRT; optimal location for lead placement during procedure★OR50Ventricular dyssynchrony imaging, echocardiographic and clinical outcomes of left bundle branch pacing and biventricular pacingVerstappen et al., Indian Pacing and Clinical Electrophysiology, 2024
Type of CRT stratificationsCSP, Lot-CRT, BiV-CRT; optimal location for lead placement during procedure★!OR35LVSP and LBBP Result in Similar or Improved LV Synchrony and Hemodynamics Compared to BVPCurila et al., JACC: Clinical Electrophysiology, 2024
Type of CRT stratificationsCSP, Lot-CRT, BiV-CRT; optimal location for lead placement during procedureCR1Resynchronization for shifting conduction patterns - When a coronary sinus lead is not enoughCurila et al., Indian Pacing and Clinical Electrophysiology, 2023
Type of CRT stratificationsCSP, Lot-CRT, BiV-CRT; optimal location for lead placement during procedure!OR80Sussenbek et al., LBBAP vs. BVP in LBBB-HF, European Heart Journal, 2023Sussenbek et al., European Heart Journal, 2023
Type of CRT stratificationsCSP, Lot-CRT, BiV-CRT; optimal location for lead placement during procedureCR1Ultra-high-frequency electrocardiography guided cardiac resynchronization therapy in a patient with an ambiguous electrocardiogramUyên Châu Nguyên, HRS, 2026
UHF-ECG maps simple to use and interpretLearn fast★RV-Ultra-High-Frequency ECG in Cardiac Pacing and Cardiac Resynchronization Therapy: From Technical Concept to Clinical ApplicationNguyên et al., Journal of Cardiovascular Development and Disease, 2023
UHF-ECG maps simple to use and interpretLearn fast★OR390Ultra-high-frequency ECG volumetric and negative derivative epicardial ventricular electrical activation patternLeinveber et al., Scientific Reports, 2024
UHF-ECG maps simple to use and interpretLearn fast★OR-3-Dimensional ventricular electrical activation pattern assessed from a novel high-frequency electrocardiographic imaging technique: principles and clinical importanceJurak et al., Scientific Reports, 2021
UHF-ECG maps simple to use and interpretLearn fast★OR-Novel ultra-high-frequency electrocardiogram tool for the description of the ventricular depolarization pattern before and during cardiac resynchronizationJurak et al., Journal of Cardiovascular Electrophysiology, 2019
UHF-ECG maps simple to use and interpretLearn fast★OR-Ventricular dyssynchrony assessment using ultra-high frequency ECG techniqueJurak et al., J Interv Card Electrophysiol, 2017
UHF-ECG correlates with mechanical dyssynchronyUHF-ECG aligns with echo★!OR53Electrical and mechanical interventricular dyssynchrony coupling in patients with bradycardia: A UHF-ECG validation trialMizner et al., Heart Rhythm, 2025
UHF-ECG correlates with mechanical dyssynchronyUHF-ECG aligns with echo!OR35LVSP and LBBP Result in Similar or Improved LV Synchrony and Hemodynamics Compared to BVPK. Curila et al., JACC EP, 2024
UHF-ECG reflects acute hemodynamic responseAB23During CRT, UHF-ECG parameters focused on LV dyssynchrony provide a comprehensive reflection of hemodynamic improvementJurak et al., EHRA, 2026
Pacemaker settings optimizationAV, VV delay, fusionPR2First In-human Reverse LOT-CRT DefibrillatorClementy et al., Authorea, 2024
Pacemaker settings optimizationAV, VV delay, fusionOR32Ultra-high Frequency ECG Mapping Assessing the Influence of VV Delays in Cardiac Resynchronisation TherapyWalton et al., HRS, 2025