Simultaneous Non‐Invasive Epicardial and Endocardial Mapping in Patients With Brugada Syndrome: New Insights Into Arrhythmia Mechanisms

Autor: Theano Papavassiliu, Volker Liebe, Vitaly Kalinin, Mikhail Chmelevsky, Marina Yakovleva, Jürgen Kuschyk, Anna Shestak, Elena Zaklyazminskaya, Susanne Röger, Ibrahim El-Battrawy, Stanislav Kim, Alexey Tsyganov, Christina Dösch, Ibrahim Akin, Boris Rudic, Erol Tülümen, Martin Borggrefe, Maria Chaykovskaya
Rok vydání: 2016
Předmět:
Epicardial Mapping
Male
02 engineering and technology
Arrhythmias
030204 cardiovascular system & hematology
depolarization
0302 clinical medicine
Arrhythmia and Electrophysiology
epicardium
Original Research
Brugada syndrome
Ajmaline
medicine.diagnostic_test
Heart
Middle Aged
Right bundle branch block
right bundle branch block
Electrophysiology
endocardium
cardiovascular system
Cardiology
Female
Cardiology and Cardiovascular Medicine
Anti-Arrhythmia Agents
ajmaline challenge
Adult
medicine.medical_specialty
electrocardiography
Heart Ventricles
Bundle-Branch Block
0206 medical engineering
sudden death
arrhythmia
Sudden death
Young Adult
03 medical and health sciences
right ventricular outflow tract
Internal medicine
medicine
Humans
Repolarization
In patient
Endocardium
repolarization
business.industry
Non invasive
medicine.disease
020601 biomedical engineering
Case-Control Studies
business
Electrocardiography
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
DOI: 10.1161/jaha.116.004095
Popis: Background The underlying mechanisms of Brugada syndrome (BrS) are not completely understood. Recent studies provided evidence that the electrophysiological substrate, leading to electrocardiogram abnormalities and/or ventricular arrhythmias, is located in the right ventricular outflow tract ( RVOT ). The purpose of this study was to examine abnormalities of epicardial and endocardial local unipolar electrograms by simultaneous noninvasive mapping in patients with BrS. Methods and Results Local epicardial and endocardial unipolar electrograms were analyzed using a novel n oninvasive e pi‐ and e ndocardial e lectrophysiology s ystem ( NEEES ) in 12 patients with BrS and 6 with right bundle branch block for comparison. Fifteen normal subjects composed the control group. Observed depolarization abnormalities included fragmented electrograms in the anatomical area of RVOT endocardially and epicardially, significantly prolonged activation time in the RVOT endocardium (65±20 vs 38±13 ms in controls; P =0.008), prolongation of the activation‐recovery interval in the RVOT epicardium (281±34 vs 247±26 ms in controls; P =0.002). Repolarization abnormalities included a larger area of ST ‐segment elevation >2 mV and T‐wave inversions. Negative voltage gradient (−2.5 to −6.0 mV) between epicardium and endocardium of the RVOT was observed in 8 of 12 BrS patients, not present in patients with right bundle branch block or in controls. Conclusions Abnormalities of epicardial and endocardial electrograms associated with depolarization and repolarization properties were found using NEEES exclusively in the RVOT of BrS patients. These findings support both, depolarization and repolarization abnormalities, being operative at the same time in patients with BrS.
Databáze: OpenAIRE
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