scholarly journals Mechanical dispersion identifies patients with extensive electroanatomic abnormalities in Brugada syndrome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Ciabatti ◽  
M Nesti ◽  
M Reccia ◽  
E Saletti ◽  
P Notarstefano ◽  
...  
Keyword(s):  
Brugada Syndrome ◽  
Low Voltage ◽  
Electrophysiological Study ◽  
Global Longitudinal Strain ◽  
Structural Heart Disease ◽  
Outflow Tract ◽  
Electroanatomic Mapping ◽  
Mechanical Dispersion ◽  
2D Echocardiography ◽  
The Right

Abstract Background Brugada syndrome (BrS) was initially described as a pure electrical disorder caused by ion channel abnormalities in the absence of structural heart disease. However, imaging, autopsy and endomyocardial biopsy studies have increasingly demonstrated in patients with BrS the presence of myocardial structural alterations of the right ventricle (RV), particularly in the outflow tract. Indeed, electroanatomic mapping studies identified electroanatomic abnormalities of the RV outflow tract in both unipolar and bipolar maps with a significant correlation between the extension of low-voltage areas and the inducibility of arrhythmias at electrophysiological study or the incidence of malignant arrhythmias during the follow up. New echocardiographic parameters have been proposed to identify subtle myocardial alterations associated with arrhythmic events. Mechanical dispersion (MD) of the left ventricle (LV) has been identified as a prognostic marker in the arrhythmic risk stratification in various cardiac diseases including some cardiomyopathies. Purpose In this study we evaluated MD and global longitudinal strain (GLS) of RV and LV in patients with BrS to identify echocardiographic correlates of the abnormalities detected by electroanatomic mapping. Methods We performed 2D-Echocardiography with speckle tracking analysis of RV and LV in patients with BrS previously submitted to RV electroanatomic mapping. All studies were performed by investigators blind to clinical features and electrophysiological findings. Echocardiographic data were compared with electroanatomic mapping and electrophysiological study findings and with clinical data. Results We enrolled 18 patients (52±11 years, male 44%). Patients with a LV MD value ≥40 ms showed a pathological unipolar area with voltage <5.5 mV significantly more extended than patients with a LV MD value <40 ms (28.49±21.06 vs 10.47±8.22; p=0.03). Patients with LV MD ≥40 ms also showed a trend to greater extension of the unipolar area with voltage <4 mV (13.94±13.11 vs 4.94±3.12; p=0.07), a greater extension of the bipolar area with voltage <1.5 mV (6.24±5.22 vs 2.24±3.15; p=0.07) and higher inducibility at programmed ventricular stimulation (70% vs 37.5%, p=0.34). No correlation was observed between RV MD or GLS values and the extent of the low-voltage areas or with the presence of genetic mutations associated with BrS. Conclusions In patients with BrS a LV MD ≥40 ms is associated with a greater extension of low-voltage areas at unipolar mapping. Echocardiographic evaluation with MD analysis may represent a valuable non-invasive tool to identify electroanatomic alterations prompting further invasive studies including electronatomic mapping and electrophysiological study. Prospective studies on larger series may further clarify the potential role of MD and electroanatomic mapping in the prognostic stratification of patients with BrS. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

scholarly journals Re-entrant ventricular tachycardia as a complication of ablation of idiopathic ventricular premature beats from the right outflow tract: a case report

2020 ◽  
Author(s):  
Nam Van Tran ◽  
Samuel Rotman ◽  
Patrice Carroz ◽  
Etienne Pruvot
Keyword(s):  
Ventricular Tachycardia ◽  
Low Voltage ◽  
Perfect Match ◽  
Right Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Ventricular Premature Beats ◽  
First Case ◽  
The Right ◽  
Premature Beats ◽  
Pace Mapping

Abstract Background We report an unusual case of non-sustained ventricular tachycardia (NSVT) from the epicardial part of the right ventricular outflow tract (RVOT). Case summary A 37-year-old woman who underwent in 2006 an ablation for idiopathic ventricular premature beats (VPBs) from the RVOT presented with pre-syncopal NSVT in 2016. A cardiac workup showed no coronary disease, normal biventricular function, and no enhancement on cardiac magnetic resonance imaging. A metabolic positron emission tomography scan excluded inflammation. Biopsies revealed normal desmosomal proteins. An endocardial mapping revealed an area of low voltage potential (<0.5 mV) at the antero-septal aspect of the RVOT corresponding to the initial site of ablation from 2006. Activation mapping revealed poor prematurity and pace-mapping showed unsatisfactory morphologies in the RVOT, the left ventricle outflow tract and the right coronary cusp. An epicardial map revealed a low voltage area at the antero-septal aspect of the RVOT with fragmented potentials opposite to the endocardial scar. Pace-mapping demonstrated perfect match. An NSVT was induced and local electrocardiogram showed mid-diastolic potentials. Ablation was applied epicardially and endocardially without any complication. The patient was arrhythmia free at 4-year follow-up. Discussion Cardiac workup allowed to exclude specific conditions such as arrhythmogenic cardiomyopathy, tetralogy of Fallot, sarcoidosis, or myocarditis as a cause for NSVT from the RVOT. The epi and endocardial map showed residual scar subsequent to the first ablation which served as substrate for the re-entrant NSVT. This is the first case which describes NSVT from the epicardial RVOT as a complication from a previous endocardial ablation for idiopathic VPB.

Dormant conduction in the right ventricular outflow tract unmasked by adenosine in a patient with Brugada syndrome

2021 ◽  
Vol 32 (4) ◽  
pp. 1182-1186
Author(s):  
Tsukasa Kamakura ◽  
Josselin Duchateau ◽  
Frédéric Sacher ◽  
Pierre Jais ◽  
Michel Haïssaguerre ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Brugada Syndrome ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Dormant Conduction ◽  
The Right

Non-contact mapping and ablation of tachycardia originating in the right ventricular outflow tract

2002 ◽  
Vol 12 (3) ◽  
pp. 294-297 ◽  
Author(s):  
Thomas Paul ◽  
Andrew T. D. Blaufox ◽  
J. Philip Saul
Keyword(s):  
Ventricular Tachycardia ◽  
Right Ventricular ◽  
Electrophysiological Study ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Mechanical Pressure ◽  
Contact Mapping ◽  
The Right ◽  
Endocardial Activation

We performed an electrophysiological study, using non-contact mapping, in an 8-year-old girl weighing 39.9 kg who had suffered recurrent symptomatic episodes of exercise-induced non-sustained ventricular tachycardia. Color-coded isopotential maps of the ventricular tachycardia identified the area of earliest endocardial activation high and anterior in the right ventricular outflow tract. Although partial deflation of the balloon was required to position the ablation catheter at the earliest site of activation, this site was still identified accurately, as demonstrated by termination of the ventricular tachycardia and ectopy upon mechanical pressure, as well as application of radiofrequency current.In this young patient, precise mapping of the earliest endocardial activation using the non-contact mapping system was safe and effective, allowing successful radiofrequency ablation of the tachycardia.

scholarly journals Early Response after Catheter Ablation of the Epicardial Substrate in a Patient with Brugada Syndrome Can Be Predicted by High Precordial Leads

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Yae Min Park ◽  
Mi Sook Cha ◽  
Hanul Choi ◽  
Woong Chol Kang ◽  
Seung Hwan Han ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Brugada Syndrome ◽  
Low Voltage ◽  
Early Stage ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Early Response ◽  
Intercostal Space ◽  
The Right ◽  
Fourth Intercostal Space

A 52-year-old male with Brugada syndrome presented with repeated and appropriate shock from an implantable cardioverter defibrillator (ICD). Catheter ablation for substrate elimination targeting low-voltage, complex, and fractionated electrocardiograms and late potentials in the epicardial right ventricular outflow tract was successfully performed. Brugada phenotype in the right precordial leads from the third intercostal space disappeared in the early stage after catheter ablation and that from the standard fourth intercostal space disappeared later. He remained free from ventricular fibrillation over the next fourteen months. We suggest that this novel ablation strategy is effective in Brugada syndrome patients with ICD, and early response after catheter ablation can be predicted by high precordial leads.

scholarly journals Novel CineECG Derived From Standard 12-Lead ECG Enables Right Ventricle Outflow Tract Localization of Electrical Substrate in Patients With Brugada Syndrome

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Peter M. van Dam ◽  
Emanuela T. Locati ◽  
Giuseppe Ciconte ◽  
Valeria Borrelli ◽  
Francesca Heilbron ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Brugada Syndrome ◽  
Predictive Value ◽  
Normal Subjects ◽  
Outflow Tract ◽  
Arrhythmogenic Substrate ◽  
The Right ◽  
Type 3 ◽  
Electrocardiogram Ecg

Background: In Brugada syndrome (BrS), diagnosed in presence of a spontaneous or ajmaline-induced type-1 pattern, ventricular arrhythmias originate from the right ventricle outflow tract (RVOT). We developed a novel CineECG method, obtained by inverse electrocardiogram (ECG) from standard 12-lead ECG, to localize the electrical activity pathway in patients with BrS. Methods: The CineECG enabled the temporospatial localization of the ECG waveforms, deriving the mean temporospatial isochrone from standard 12-lead ECG. The study sample included (1) 15 patients with spontaneous type-1 Brugada pattern, and (2) 18 patients with ajmaline-induced BrS (at baseline and after ajmaline), in whom epicardial potential duration maps were available; (3) 17 type-3 BrS pattern patients not showing type-1 BrS pattern after ajmaline (ajmaline-negative); (4) 47 normal subjects; (5) 18 patients with right bundle branch block (RBBB). According to CineECG algorithm, each ECG was classified as Normal, Brugada, RBBB, or Undetermined. Results: In patients with spontaneous or ajmaline-induced BrS, CineECG localized the terminal mean temporospatial isochrone forces in the RVOT, congruent with the arrhythmogenic substrate location detected by epicardial potential duration maps. The RVOT location was never observed in normal, RBBB, or ajmaline-negative patients. In most patients with ajmaline-induced BrS (78%), the RVOT location was already evident at baseline. The CineECG classified all normal subjects and ajmaline-negative patients at baseline as Normal or Undetermined, all patients with RBBB as RBBB, whereas all patients with spontaneous and ajmaline-induced BrS as Brugada. Compared with standard 12-lead ECG, CineECG at baseline had a 100% positive predictive value and 81% negative predictive value in predicting ajmaline test results. Conclusions: In patients with spontaneous and ajmaline-induced BrS, the CineECG localized the late QRS activity in the RVOT, a phenomenon never observed in normal, RBBB, or ajmaline-negative patients. The possibility to identify the RVOT as the location of the arrhythmogenic substrate by the noninvasive CineECG, based on the standard 12-lead ECG, opens new prospective for diagnosing patients with BrS.

scholarly journals Fever Associated with Gastrointestinal Shigellosis Unmasks Probable Brugada Syndrome

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
John N. Makaryus ◽  
Jennifer Verbsky ◽  
Scott Schwarz ◽  
David Slotwiner
Keyword(s):  
Brugada Syndrome ◽  
Ventricular Arrhythmias ◽  
Structural Heart Disease ◽  
Underlying Mechanism ◽  
Temperature Dependent ◽  
Bundle Branch Block ◽  
St Segment ◽  
Electrocardiographic Changes ◽  
Clinically Significant ◽  
The Right

Since it was first described approximately 15 years ago, the Brugada Syndrome has spurred a significant quantity of interest in its underlying mechanism and physiology. The Brugada electrocardiographic pattern is characterized by right bundle branch block morphology and ST segment elevations in the right precordial leads with an absence of identifiable underlying structural heart disease. The syndrome is clinically significant since these patients are at a higher risk of developing malignant ventricular arrhythmias. One of the mechanisms behind the disorder involves mutations in specific myocardial sodium channels. Furthermore, these electrocardiographic changes appear to be temperature dependent. We present the case of a 35-year-old male who presented with intestinal Shigellosis and was also found to have Brugada-type electrocardiographic changes on ECG. The electrocardiographic changes that were present when the patient was admitted and febrile resolved following antibiotic therapy and defervescence.

scholarly journals Clinical and functional characteristics of children with ventricular arrhythmias depending on the ectopic focus localization

2021 ◽  
Vol 28 (4) ◽  
pp. 15-23
Author(s):  
O. V. Yeliseyeva
Keyword(s):  
Sinus Rhythm ◽  
Ventricular Arrhythmias ◽  
Contractile Function ◽  
Electrophysiological Study ◽  
Stress Test ◽  
Structural Heart Disease ◽  
Holter Monitoring ◽  
Free Wall ◽  
Functional Features ◽  
The Right

Aim. To determine the prevalence of ventricular arrhythmias (VA) among children with cardiac arrhythmias and to assess the clinical, functional, and electrophysiological characteristics of VA, depending on the localization of the ectopic focus.Methods. The study included 260 children, 153 (58,8%) boys, the mean age of patients was 13.4±3.1years. Based on clinical and anamnestic data, ECG, Holter monitoring, echocardiography, dosed exercise test, invasive electrophysiological study (EPS), radiofrequency ablation (RFA) a comparative assessment of the clinical and functional features of the most frequently diagnosed localizations of the ectopic focus in children with VA was carried out according to the data of invasive EPS, RFA.Results. According to invasive EPI, the most frequent localization of VA in children is the right ventricle outflow tract (RVOT) - 144 (55%), less often - the Valsalva sinuses - 52 (20%) and the RV free wall - 47 (18%). In most cases (255 children, 98%) there was a focal arrhythmia (trigger activity). The localization of ectopia in the RV free wall is characterized by the predominance of single ventricular premature beats (VPB) or in combination with a paired VPB (78,7%) and polymorphism of ventricular complexes (30%). The peculiarity of ventricular tachycardia in this localization is its stable character (17,0%) and low heart rate in volleys (idioventricular rhythm) (12,8%). When the focus was localized in the RVOT, as well as when it was localized in the RV free wall, single VPB or in combination with paired VPB prevailed (84,7%), but polymorphism of ventricular complexes was less often observed (10,4%). Differences in myocardial contractility at the sinus rhythm in right ventricular arrhythmias were revealed. Thus, the ejection fraction at the localization of the lesion in the RV free wall was significantly lower than in the RVOT (63.4±5.5% and 65.8±5.9%, respectively; p<0.01). Hemodynamic significance is characteristic for RV arrhythmias (21.3% and 16.0% of patients) and was practically not observed at the left-sided localization of the arrhythmogenic focus (3.8%; p<0.01). VA in patients without structural heart disease, regardless of the localization of the arrhythmic focus in children, is asymptomatic and is detected, in most cases, within the framework of clinical examination 206 patients, 79.2%. The prevalence of syncope in children with idiopathic VA is 15.8% (41 patients), and in most cases, they are of vaso-vagal origin. In most children (178, 70%), idiopathic VA is dependent on the level of parasympathetic influences on the heart, disappearing or significantly decreasing during exercise, which is revealed during the stress test confirming the high role of autonomic influences on the regulation of heterotopic rhythm in children with VA.Conclusion. VA is a common arrhythmia in children. Depending on the localization of the arrhythmogenic focus, characteristic features of the structure and density of the heart, as well as differences in the contractile function of the myocardium on the sinus rhythm and on the ectopic complex were revealed.

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