Heart failure & cardiomyopathiesCohort study
Ultra-high-frequency Electrocardiography (UHF-ECG) Outperforms QRS Duration and Morphology in Predicting Responders to Biventricular Cardiac Resynchronization Therapy
- prospective single-center study
Authors' conclusion
UHF-ECG-derived ventricular dyssynchrony predicts response to CRT more accurately than conventional ECG parameters. Both baseline e-DYS and its postimplant reduction identify patients most likely to benefit from biventricular pacing.
Study context
- Population
- Patients with heart failure, sinus rhythm, nonright bundle branch block morphology, LVEF ≤35%, and QRS duration >130 millisecondsenrolled and followed for 6 months
- Participants
- 114 patients
- Exposure
- Electrical dyssynchrony (e-DYS) derived from UHF-ECG compared with QRS duration, QRS area, negative derivatve action time (NDAT) V8, and QRS morphology for predicting cardiac resynchronization therapy (CRT) response
- Respondersn = 73
Main finding
As reported in the abstract
CRT response · 6 months
Responders
64%
73 of 73
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | P value |
|---|---|---|
| Independent predictors of response (multivariable analysis) — e-DYS | OR 1.02 per ms | P = 0.04 |
| Independent predictors of response (multivariable analysis) — nonischemic cardiomyopathy | OR 2.8 | P = 0.03 |
- Independent predictors of response (multivariable analysis): only e-DYS and nonischemic cardiomyopathy independently predicted response
Baseline characteristics of responders
- Responders more often had nonischemic cardiomyopathy, larger QRS area, longer QRS duration, and greater e-DYS
Optimal cutoffs for CRT response prediction
- e-DYS
- >55 ms
- QRS area
- >81 μVs
- NDAT V8
- >117 ms
- QRS duration
- >155 ms
Independent predictors in ischemic cardiomyopathy
- e-DYS remained the sole independent predictor
Postimplant Δe-DYS prediction of response
- Δe-DYS
- −37 ms
- AUC
- 0.73, 95% CI: 0.63-0.83
- More accurate than ΔQRS area or ΔQRS duration
Original publication
UHF-ECG Outperforms QRS Duration and Morphology in Predicting Responders to Biventricular Cardiac Resynchronization Therapy. JACC Clin Electrophysiol. Published 17 June 2026. doi:10.1016/j.jacep.2026.04.035
Summarised from the published abstract; every number is checked against it