160847 20251017144550.0 doi 10.1038/s41598-025-98608-6 sideral 144059 ART-2025-144059 eng Sales-Belles, Clara Universidad de Zaragoza ECG-based evaluation of ventricular synchrony in left bundle branch area pacing through characterization of the activation sequence 2025 Access copy available to the general public Unrestricted Left bundle branch area pacing (LBBAP) overcomes ventricular dyssynchrony induced by conventional right ventricular pacing (RVP). Despite QRS duration (QRSd) being the standard ECG marker for biventricular synchrony, it lacks insights into the ventricular activation sequence. Our aim is to assess biventricular synchrony by characterizing the ventricular activation sequence and introducing robust markers using the 12-lead ECG. A prospective single-center study was conducted, involving patients with pacemaker indication due to bradycardia. Patients were divided into LBBAP and RVP, and classified by baseline-QRS morphology. To assess biventricular synchrony, low frequency-based QRS analysis was performed to compute the ventricular activation sequence and precordial activation delay (pAD). Additional QRS markers including QRSd, QRS60, and QRS area (QRSa) were calculated. A total of 176 patients (107 LBBAP, 69 RVP) were included. The paced ventricular activation sequence indicated a more physiological pattern after LBBAP than RVP, with lower pAD values in narrow QRS, RBBB, and LBBB subgroups [ − 10( − 20,14) vs. 26(5, 39) ms;  − 18( − 30,  − 8) vs. 34(26, 55) ms; 10( − 14, 25) vs. 32(12, 48) ms] (p < 0.01). In all subgroups, QRS60 showed lower values after LBBAP than RVP [52(41, 62) vs.73(65, 80) ms; 60(55, 66) vs. 77(67, 83) ms; 59(53, 64) vs. 77(74, 82) ms] (p < 0.01) and QRSa were also lower [53(38, 66) vs. 121(92, 143) μVs; 60(50, 89) vs. 124(97, 159) μVs; 62(52, 80) vs. 133(99, 148) μVs] (p < 0.01). pAD provides valuable insights into ventricular activation beyond paced-QRSd. Together with QRS60 and QRSa, pAD could be a promising tool to assess biventricular synchrony. info:eu-repo/grantAgreement/ES/AEI/PID2021-128972OA-I00 info:eu-repo/grantAgreement/ES/DGA/LMP94_21 info:eu-repo/grantAgreement/ES/DGA/T39-23R info:eu-repo/grantAgreement/ES/MICINN/CNS2022-135899 info:eu-repo/grantAgreement/ES/MICINN/PID2022-140556OB-I00 info:eu-repo/grantAgreement/ES/MICINN/RYC2019-027420-I info:eu-repo/grantAgreement/EUR/MICINN/TED2021-130459B-I00 info:eu-repo/semantics/openAccess by-nc-nd https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Mincholé, Ana Universidad de Zaragoza (orcid)0000-0003-3183-4107 Melero-Polo, Jorge Cabrera-Ramos, Mercedes Universidad de Zaragoza Vadillo-Martín, Pablo Montilla-Padilla, Isabel Universidad de Zaragoza Sorinas-Villanueva, Laura Julián-García, Inés Mayo-Carlos, Gualber Vitto Ruiz-Arroyo, José Ramón Pueyo, Esther Universidad de Zaragoza (orcid)0000-0002-1960-407X Ramos-Maqueda, Javier Universidad de Zaragoza 1007 610 Universidad de Zaragoza Dpto. Medicina, Psiqu. y Derm. Area Medicina 5008 800 Universidad de Zaragoza Dpto. Ingeniería Electrón.Com. Área Teoría Señal y Comunicac. 15 (2025), 15584 [12 pp.] Sci. rep. (Nat. Publ. Group) Scientific reports (Nature Publishing Group) 2045-2322 2289528 http://zaguan.unizar.es/record/160847/files/texto_completo.pdf Versión publicada 2360023 http://zaguan.unizar.es/record/160847/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:160847 articulos driver 2025-10-17-14:11:36 ARTICLE