Demonstration of Arrhythmia Substrate-Associated Dispersion of Repolarization by Epicardial Unipolar Mapping in Brugada Syndrome.

Autor:	Nagase S; Department of Advanced Arrhythmia and Translational Medical Science, National Cerebral and Cardiovascular Center, Suita, Japan. Electronic address: snagasenagase@gmail.com., Kataoka N; Second Department of Internal Medicine, University of Toyama, Toyama, Japan., Morita H; Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan., Kamakura T; Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Ueoka A; Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan., Nakamura T; Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Oka S; Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Miyazaki Y; Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Wakamiya A; Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Nakajima K; Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Ueda N; Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Wada M; Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Ishibashi K; Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Inoue Y; Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Miyamoto K; Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Aiba T; Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan., Kusano K; Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Jazyk:	angličtina
Zdroj:	JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2024 Jul; Vol. 10 (7 Pt 2), pp. 1576-1588. Date of Electronic Publication: 2024 May 16.
DOI:	10.1016/j.jacep.2024.05.012
Abstrakt:	Background: Epicardial unipolar mapping has not been thoroughly investigated in Brugada syndrome (BrS). Objectives: This study aims to examine the characteristics of epicardial unipolar potentials in BrS and investigate the differences from overt cardiomyopathy. Methods: Epicardial mapping was performed in 8 patients with BrS and 6 patients with cardiomyopathy. We investigated the J-wave amplitudes using unipolar recordings at delayed potential (DP) sites via bipolar recordings. The repolarization time (RT) at and around the DP recording sites was measured, and maximum dispersion of the RT divided by the distance was defined as the RT dispersion index. Results: Epicardial mapping at baseline revealed significantly higher J-wave amplitude with bipolar DP in patients with BrS than in patients with cardiomyopathy. J-wave amplitude ≥0.42 mV had 99.1% sensitivity and 100% specificity for diagnosing BrS. The RT dispersion index was significantly higher in patients with BrS than in patients with cardiomyopathy at baseline. In all patients with BrS, coved-type unipolar electrograms without negative T waves (short RT) appeared close to coved-type electrograms with negative T waves (long RT) at the DP recording sites after pilsicainide administration. Thus, a steep RT dispersion was observed in this region, and ventricular arrhythmias emerged from this shorter RT area in all 3 patients with BrS in whom ventricular arrhythmias were induced. Conclusions: Bipolar DP-related prominent unipolar J waves and steep repolarization gradients may be more specific for characterizing BrS than for overt cardiomyopathy. Ventricular arrhythmias in BrS are associated with a steep repolarization gradient, indicating phase 2 re-entry as a possible cause. Competing Interests: Funding Support and Author Disclosures Drs Nagase and Morita are affiliated with departments that receive grants from Medtronic. Dr Kataoka has received grants from Medtronic; and has received speaker fees from Medtronic, Biosense Webster, and Abbott. Drs Kamakura, Wakamiya , and Nakajima have received speaker fees from Medtronic and Biosense Webster. Dr Ueda has received speaker fees from Medtronic. Dr Ishibashi has received speaker fees from Medtronic, Abbott, and Japan Lifeline. Dr Miyamoto has received grants from Medtronic, Biosense Webster, and Abbott; and has received speaker fees from Medtronic, Biosense Webster, and Abbott. Dr Kusano has received grants from Medtronic, Biosense Webster, and Abbott; and has received speaker fees from Medtronic and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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