Site‐Specific Arrhythmogenesis in Patients with Brugada Syndrome
- 23 April 2003
- journal article
- research article
- Published by Wiley in Journal of Cardiovascular Electrophysiology
- Vol. 14 (4), 373-379
- https://doi.org/10.1046/j.1540-8167.2003.02365.x
Abstract
Introduction: It has been believed that electrophysiologic abnormality of the epicardial region of the right ventricular free wall may play an important role in arrhythmogenesis of phase 2 reentry in Brugada syndrome, but clinical evidence of the occurrence of ventricular arrhythmias at the right ventricular free wall has not been evaluated. In this study, we evaluated the site-specific inducibility of ventricular fibrillation (VF) and the origin of spontaneous premature ventricular contractions (PVCs) in patients with Brugada syndrome. Methods and Results. Forty-five patients with Brugada-type ECG were enrolled in this study. Spontaneous PVCs were recorded in 9 patients. Programmed electrical stimulation (PES) was performed at the right ventricular apex (RVA), the free wall and septal region of the right ventricular outflow tract (RVOT), and the left ventricle (LV). The inducibility of PVT/VF was evaluated at each ventricular site, and the origin of PVC was determined by pace mapping. Sustained VF was induced in 17 patients. VF was induced in all 17 patients by PES at RVOT. Although PES at the septal region of the RVOT induced VF in only 5 patients (29%), PES at the free-wall region of the RVOT induced PVT/VF in 13 patients (76%). PES at RVA induced VF in only 2 patients (12%), and PES at LV failed to induce any arrhythmic events. Ventricular pace mapping showed that 64% of PVCs occurred at the free-wall region of the RVOT, 18% at the septal region of the RVOT, 9% at RVA, and 9% at LV. Conclusion: VF in patients with Brugada syndrome frequently is induced at the free-wall region of the RVOT area. The origin of PVC appears to be related to the site of PVT/VF induction by PES. (J Cardiovasc Electrophysiol, Vol. 14, pp. 373-379, April 2003)Keywords
This publication has 31 references indexed in Scilit:
- Epicardial electrogram of the right ventricular outflow tract in patients with the brugada syndrome: Using the epicardial leadJournal of the American College of Cardiology, 2002
- Natural History of Brugada SyndromeCirculation, 2002
- 'Localized' right ventricular morphological abnormalities in patients with the Brugada syndrome: what is their significance?European Heart Journal, 2001
- Localized right ventricular morphological abnormalities detected by electron-beam computed tomography represent arrhythmogenic substrates in patients with the Brugada syndromeEuropean Heart Journal, 2001
- The Brugada syndrome: diagnostic criteria and cellular mechanismsEuropean Heart Journal, 2001
- Sodium “Channelopathies” and Sudden DeathCirculation Research, 1999
- “Brugada” SyndromeCirculation, 1999
- Genetic basis and molecular mechanism for idiopathic ventricular fibrillationNature, 1998
- Right Bundle-Branch Block and ST-Segment Elevation in Leads V 1 Through V 3Circulation, 1998
- Familial cardiomyopathy underlies syndrome of right bundle branch block, ST segment elevation and sudden deathJournal of the American College of Cardiology, 1996