Abstract 1832: Location of Making Type 1 Electrocardiogram in Brugada Syndrome: Comparison between Lead Position and Anatomical Location of Right Ventricular Outflow Tract

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Satoshi Nagase ◽  
Shigeki Hiramatsu ◽  
Nobuhiro Nishii ◽  
Masato Murakami ◽  
Takeshi Tada ◽  
...  
Keyword(s):  
Brugada Syndrome ◽  
Channel Blocker ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Anatomical Location ◽  
Sodium Channel Blocker ◽  
Fluoroscopic Image ◽  
Ecg Leads ◽  
The Relationship

Introduction: Recording type 1 ECG in right precordial leads in the presence or absence of a sodium channel blocker is a diagnostic criterion in Brugada syndrome (BrS). It was also suggested that right ventricular outflow tract (RVOT) is the arrhythmogenic substrate in BrS. However, we occasionally observed type 1 ECG only in the third intercostal space (3ics), not standard fourth intercostal space (4ics). Accordingly, we examined the relationship between the position of ECG leads manifesting type 1 and anatomical location of RVOT under fluoroscopic image. Methods: Total 33 BrS patients were examined in this study. All patients had more than one of the following: documented ventricular fibrillation (VF), several episodes of syncope, a family history of sudden death, SCN5A mutation or inducibility of VF by programmed electrical stimulation. Anatomical location of the RVOT was determined under fluoroscopic image with right ventriculography. ECG was also recorded at the 3ics in leads V1 and V2 in addition to the standard V1 and V2 at the 4ics with fluoroscopically visible electrodes. A pure sodium channel blocker, pilsicainide, was administered in all patients without manifesting type 1 ECG under baseline conditions. Relationships between anatomical location and the position of ECG leads manifesting type 1 were examined in all patients. Results: Type 1 ECG was recorded in all patients with pilsicainide administration. The location of RVOT corresponded with lead V1 and V2 at the 4ics in 5 patients and at the 3ics in 28 patients. In 4 out of 5 patients (80.0%) corresponding RVOT with 4ics, type 1 ECG was recorded at the 4ics. However, in 24 out of 28 patients (85.7%) corresponding RVOT with 3ics, type 1 ECG was recorded only at the 3ics. Furthermore, in 7 out of 12 symptomatic patients (58.3%) with documented VF or syncope, type 1 ECG was not recorded at the 4ics, however, could be detected at the 3ics without pilsicainide administration. The location of RVOT was not different between symptomatic and asymptomatic patients. Conclusions: Type 1 ECG is predominantly caused at the RVOT, and the relationship between the position of ECG lead and the RVOT is variable. Recording ECG at the 3ics in addition to the standard 4ics in the right precordial leads is convincing in diagnosis of BrS.

scholarly journals Left Axis Deviation in Brugada Syndrome: Vectorcardiographic Evaluation during Ajmaline Provocation Testing Reveals Additional Depolarization Abnormalities

2021 ◽  
Vol 22 (2) ◽  
pp. 484
Author(s):  
Martijn H. van der Ree ◽  
Jeroen Vendrik ◽  
Jan A. Kors ◽  
Ahmad S. Amin ◽  
Arthur A. M. Wilde ◽  
...  
Keyword(s):  
Sodium Channel ◽  
Brugada Syndrome ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Conduction Delay ◽  
Channel Blockers ◽  
Axis Deviation ◽  
Provocation Testing ◽  
The Right

Patients with Brugada syndrome (BrS) can show a leftward deviation of the frontal QRS-axis upon provocation with sodium channel blockers. The cause of this axis change is unclear. In this study, we aimed to determine (1) the prevalence of this left axis deviation and (2) to evaluate its cause, using the insights that could be derived from vectorcardiograms. Hence, from a large cohort of patients who underwent ajmaline provocation testing (n = 1430), we selected patients in whom a type-1 BrS-ECG was evoked (n = 345). Depolarization and repolarization parameters were analyzed for reconstructed vectorcardiograms and were compared between patients with and without a >30° leftward axis shift. We found (1) that the prevalence of a left axis deviation during provocation testing was 18% and (2) that this left axis deviation was not explained by terminal conduction slowing in the right ventricular outflow tract (4th QRS-loop quartile: +17 ± 14 ms versus +13 ± 15 ms, nonsignificant) but was associated with a more proximal conduction slowing (1st QRS-loop quartile: +12[8;18] ms versus +8[4;12] ms, p < 0.001 and 3rd QRS-loop quartile: +12 ± 10 ms versus +5 ± 7 ms, p < 0.001). There was no important heterogeneity of the action potential morphology (no difference in the ventricular gradient), but a left axis deviation did result in a discordant repolarization (spatial QRS-T angle: 122[59;147]° versus 44[25;91]°, p < 0.001). Thus, although the development of the type-1 BrS-ECG is characterized by a terminal conduction delay in the right ventricle, BrS-patients with a left axis deviation upon sodium channel blocker provocation have an additional proximal conduction slowing, which is associated with a subsequent discordant repolarization. Whether this has implications for risk stratification is still undetermined.

scholarly journals Longer Repolarization in the Epicardium at the Right Ventricular Outflow Tract Causes Type 1 Electrocardiogram in Patients With Brugada Syndrome

2008 ◽  
Vol 51 (12) ◽  
pp. 1154-1161 ◽  
Author(s):  
Satoshi Nagase ◽  
Kengo Fukushima Kusano ◽  
Hiroshi Morita ◽  
Nobuhiro Nishii ◽  
Kimikazu Banba ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Brugada Syndrome ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
The Right

scholarly journals Long-term evolution of echocardiography parameters in Brugada syndrome patients

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Scheirlynck ◽  
A Motoc ◽  
C De Asmundis ◽  
J Sieira ◽  
J Koulalis ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Brugada Syndrome ◽  
Structural Changes ◽  
Structural Evolution ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): ESC Research Grant Background Brugada syndrome is a heritable disorder with a high risk of sudden death. Although being a primary electrical disorder, subtle structural changes have repeatedly been described. Little is known about the long-term structural evolution in Brugada syndrome. Purpose We aimed to assess the evolution of echocardiographic parameters in Brugada syndrome and the presence of markers of structural evolution. Methods Brugada syndrome patients with minimum two complete transthoracic echocardiographic examinations were included. Clinical data were collected retrospectively. We analyzed all available echocardiographic examinations and assessed the evolution of cardiac parameters over time and its association with patient characteristics.  Results The study included 113 Brugada syndrome patients [47 (33-55) years, 59 (52%) female, spontaneous type 1 ECG in 26 (23%)], with a total of 258 echocardiographies, collected over a period of 6.8 (6.6-7.1) years. Proximal and distal right ventricular outflow tract and basal right ventricular diameter dilated at a rate of 0.2 (0.1-0.3) mm/year (p = 0.004), 0.4 (0.3-0.5) mm/year (p &lt; 0.001) and 0.6 (0.4-0.8) mm/year (p &lt; 0.001) respectively (Figure). Left ventricular mechanical dispersion increased from 38 (±11) ms to 42 (±12) ms (p = 0.001). Neither male sex, nor presenting a spontaneous type 1 ECG pattern were associated with worse structural evolution. Conclusion We observed progressive right ventricular outflow tract and basal right ventricle dilation and an increasing contractile dyssynchrony in Brugada syndrome, potentially indicating a progressive structural affection. Further research is warranted to unravel underlying mechanisms and possible clinical implications of progressive structural changes in Brugada syndrome. Abstract Figure.

Predictors of success for Brugada syndrome epicardial ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Grossi ◽  
F Bianchi ◽  
A Blandino ◽  
A Sibona Masi ◽  
C Pintor ◽  
...  
Keyword(s):  
Brugada Syndrome ◽  
Low Voltage ◽  
Low Frequency ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Control Mode ◽  
Epicardial Ablation ◽  
Single Procedure ◽  
Risk Patients

Abstract   Epicardial right ventricular outflow tract (RVOT) ablation has been described for the treatement of Brugada syndrome (BrS) high risk patients. Purpose Success evaluation of epicardial ablation for BrS. Methods Type 1 ECG was defined as spontaneous if recorded in absence of drugs and/or specific conditions. BrS patients were scheduled for ablation if presented at least one of: spontaneous type 1 ECG, syncope, ventricular arrhythmias (VA). Programmed electrical stimulation (PES) was performed (2 extrastimuli, 2 sites) in basal conditions and after ajmaline infusion. Epicardial subxifoid access and electroanatomical endo-epicardial maps were obtained during sinus rhythm. Delayed fragmented/low-frequency, low-voltage electrograms (EGM) were targeted: substrate area measured in basal conditions and after ajmaline. Epicardial ablation Radiofrequency (RF) was delivered (50 W power control mode) till complete elimination of targeted EGM and BrS-ECG pattern after ajmaline. Eventually PES repeated: if positive a repeated PES scheduled at follow-up (fu). Success was defined as absence of type 1 ECG either spontaneous or with ajmaline challenge at 3 month. Recurrences were scheduled to redo ablation. Results 55 patients were submitted to 58 ablation procedures. 38 spontaneous type 1 ECG: 18 symptomatic for syncope/polimorphic VT/VF or appropriate ICD shock; 13 had VA induction at PES. 4 patients with ajmaline-type 1 ECG had VA induction. 36% of the symptomatic patients and 26% of asymptomatic had PES-VA induction. In all patients abnormal EGM area (cm2) was detected in epicardial RVOT (table 1). Acute success: No patient had ECG type 1 with ajmaline. 5 patients had PES induction of VA. Complications: 1 cardiac tamponade, 16 mild pericarditis. At FU of 1,1±0,6 yrs no patient had spontaneous ECG type 1 nor arrhythmic events. 50 had negative ajmaline challenge (90% success rate after single procedure), 3 underwent redo: 2 had negative ajmaline challenge at FU, 1 had persistence type 1-ajmaline induction; 2 are scheduled for redo. No patient had VT induction at PES. Multivariate analysis: Single procedure success was not related either to history (symptoms, VA, type 1 ECG) or to procedural findings (PES results, substrate area). Conclusion Epicardial substrate ablation was safe end effective in BrS. No clinical or procedural findings were related to success Funding Acknowledgement Type of funding source: None

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

scholarly journals B-PO04-024 PREDICTION OF A POSITIVE SODIUM CHANNEL BLOCKER PROVOCATION TEST IN PATIENTS SUSPECTED OF BRUGADA SYNDROME

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S289
Author(s):  
Martijn Hendrik van der Ree ◽  
Jeroen Vendrik ◽  
Tom E. Verstraelen ◽  
Jan A. Kors ◽  
Ahmad S. Amin ◽  
...  
Keyword(s):  
Sodium Channel ◽  
Brugada Syndrome ◽  
Channel Blocker ◽  
Provocation Test ◽  
Sodium Channel Blocker

scholarly journals Evaluation of the Mandibular Incisive Canal by Panoramic Radiography and Cone-Beam Computed Tomography

2018 ◽  
pp. 1-13
Author(s):  
Pablo E Tauber ◽  
Virginia Mansilla ◽  
Pedro Brugada ◽  
Sara S Sánchez P ◽  
Stella M Honoré ◽  
...  
Keyword(s):  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Qrs Complex ◽  
Incisive Canal ◽  
St Segment Elevation ◽  
Longitudinal Plane ◽  
St Segment ◽  
Endocardial Mapping ◽  
The Right

Background: Radiofrequency ablation (RFA) in Brugada syndrome (BrS) has been performed both endocardially and epicardially. The substrate in BrS is thus unclear. Objectives: To investigate the functional endocardial substrate and its correlation with clinical, electrophysiological and ECG findings in order to guide an endocardial ablation. Methods: Thirteen patients (38.7±12.3 years old) with spontaneous type 1 ECG BrS pattern, inducible VF with programmed ventricular stimulation (PVS) and syncope without prodromes were enrolled. Before to endocardial mapping the patients underwent flecainide testing with the purpose of measuring the greatest ST-segment elevation for to be correlated with the size and location of substrate in the electro-anatomic map. Patients underwent endocardial bipolar and electro-anatomic mapping with the purpose of identify areas of abnormal electrograms (EGMs) as target for RFA and determine the location and size of the substrate. Results: When the greatest ST-segment elevation was in the 3rd intercostal space (ICS), the substrate was located upper in the longitudinal plane of the right ventricular outflow tract (RVOT) and a greatest ST-segment elevation in 4th ICS correspond with a location of substrate in lower region of longitudinal plane of RVOT. A QRS complex widening on its initial and final part, with prolonged transmural and regional depolarization time of RVOT corresponded to the substrate locateded in the anterior-lateral region of RVOT. A QRS complex widening rightwards and only prolonged transmural depolarization time corresponded with a substrate located in the anterior, anterior-septal or septal region of RVOT. RFA of endocardial substrate suppressed the inducibility and ECG BrS pattern during 34.7±15.5 months. After RFA, flecainide testing confirmed elimination of the ECG BrS pattern. Endocardial biopsy showed a correlation between functional and ultrastructural alterations in two patients.

Hybrid thoracoscopic epicardial ablation of right ventricular outflow tract in patients with Brugada syndrome

Heart Rhythm ◽  
2019 ◽  
Vol 16 (6) ◽  
pp. 879-887 ◽  
Author(s):  
Francesca Salghetti ◽  
Carlo de Asmundis ◽  
Juan Sieira ◽  
Hugo Enrique Coutiño ◽  
Juan Pablo Abugattas ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Brugada Syndrome ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Epicardial Ablation
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