1
|
Martini B, Martini N, De Mattia L, Buja G. Delayed depolarization and histologic abnormalities underlie the Brugada syndrome. Pacing Clin Electrophysiol 2023; 46:172-181. [PMID: 36542434 DOI: 10.1111/pace.14650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Brugada syndrome (BrS) is a controversial disease whose pathophysiology is still far from being fully understood. Unlike other cardiological disorders, a definite etiology has not yet been established so that it could be summarized under two main chapters: "functional" or "organic", "repolarization" or "depolarization" disorder. Despite initial descriptions leaned towards the organic substrate and delayed depolarization features, functional and repolarization theories have attracted most of the Cardiological attention for many years. Data from electrocardiography, endocavitary tracings, electroanatomic mapping and histopathology, however, demonstrated that BrS is mainly characterized by structural myocardial changes mostly at the right ventricular outflow tract (RVOT), but also at the right ventricle (RV) and by delayed conduction at the same sites. Conduction disorders at different levels may also be present and identify patients at high risk for major arrhythmic events. The aim of the present review is to provide the current state of art of the pathophysiology of BrS, focusing on electro-vectorcardiography and electrophysiological features, histopathology, echocardiography, and cardiac magnetic resonance imaging (CMRI).
Collapse
Affiliation(s)
| | - Nicolò Martini
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Gianfranco Buja
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| |
Collapse
|
2
|
Structural Heart Alterations in Brugada Syndrome: Is it Really a Channelopathy? A Systematic Review. J Clin Med 2022; 11:jcm11154406. [PMID: 35956023 PMCID: PMC9368908 DOI: 10.3390/jcm11154406] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Brugada syndrome (BrS) is classified as an inherited cardiac channelopathy attributed to dysfunctional ion channels and/or associated proteins in cardiomyocytes rather than to structural heart alterations. However, hearts of some BrS patients exhibit slight histologic abnormalities, suggesting that BrS could be a phenotypic variant of arrhythmogenic cardiomyopathy. We performed a systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA) criteria. Our comprehensive analysis of structural findings did not reveal enough definitive evidence for reclassification of BrS as a cardiomyopathy. The collection and comprehensive analysis of new cases with a definitive BrS diagnosis are needed to clarify whether some of these structural features may have key roles in the pathophysiological pathways associated with malignant arrhythmogenic episodes.
Collapse
|
3
|
Delinière A, Baranchuk A, Giai J, Bessiere F, Maucort-Boulch D, Defaye P, Marijon E, Le Vavasseur O, Dobreanu D, Scridon A, Da Costa A, Delacrétaz E, Kouakam C, Eschalier R, Extramiana F, Leenhardt A, Burri H, Winum PF, Taieb J, Bouet J, Fauvernier M, Rosianu H, Carabelli A, Duband B, Chevalier P. Prediction of ventricular arrhythmias in patients with a spontaneous Brugada type 1 pattern: the key is in the electrocardiogram. Europace 2020; 21:1400-1409. [PMID: 31177270 DOI: 10.1093/europace/euz156] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/15/2019] [Indexed: 01/14/2023] Open
Abstract
AIMS There is currently no reliable tool to quantify the risks of ventricular fibrillation or sudden cardiac arrest (VF/SCA) in patients with spontaneous Brugada type 1 pattern (BrT1). Previous studies showed that electrocardiographic (ECG) markers of depolarization or repolarization disorders might indicate elevated risk. We aimed to design a VF/SCA risk prediction model based on ECG analyses for adult patients with spontaneous BrT1. METHODS AND RESULTS This retrospective multicentre international study analysed ECG data from 115 patients (mean age 45.1 ± 12.8 years, 105 males) with spontaneous BrT1. Of these, 45 patients had experienced VF/SCA and 70 patients did not experience VF/SCA. Among 10 ECG markers, a univariate analysis showed significant associations between VF/SCA and maximum corrected Tpeak-Tend intervals ≥100 ms in precordial leads (LMaxTpec) (P < 0.001), BrT1 in a peripheral lead (pT1) (P = 0.004), early repolarization in inferolateral leads (ER) (P < 0.001), and QRS duration ≥120 ms in lead V2 (P = 0.002). The Cox multivariate analysis revealed four predictors of VF/SCA: the LMaxTpec [hazard ratio (HR) 8.3, 95% confidence interval (CI) 2.4-28.5; P < 0.001], LMaxTpec + ER (HR 14.9, 95% CI 4.2-53.1; P < 0.001), LMaxTpec + pT1 (HR 17.2, 95% CI 4.1-72; P < 0.001), and LMaxTpec + pT1 + ER (HR 23.5, 95% CI 6-93; P < 0.001). Our multidimensional penalized spline model predicted the 1-year risk of VF/SCA, based on age and these markers. CONCLUSION LMaxTpec and its association with pT1 and/or ER indicated elevated VF/SCA risk in adult patients with spontaneous BrT1. We successfully developed a simple risk prediction model based on age and these ECG markers.
Collapse
Affiliation(s)
- Antoine Delinière
- Service de Rythmologie, Centre National de Référence des Troubles du Rythme Cardiaque Héréditaires de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France & Université de Lyon, Lyon, France
| | | | - Joris Giai
- Service de Biostatistiques et Bioinformatique, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Francis Bessiere
- Service de Rythmologie, Centre National de Référence des Troubles du Rythme Cardiaque Héréditaires de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France & Université de Lyon, Lyon, France
| | - Delphine Maucort-Boulch
- Service de Biostatistiques et Bioinformatique, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Pascal Defaye
- Service de Rythmologie, Département de Cardiologie, CHU de Grenoble, Grenoble, France
| | - Eloi Marijon
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Dan Dobreanu
- Department of Physiology, University of Medicine and Pharmacy of Târgu Mureș, Târgu Mureș, Romania
| | - Alina Scridon
- Department of Physiology, University of Medicine and Pharmacy of Târgu Mureș, Târgu Mureș, Romania
| | - Antoine Da Costa
- Pôle Cardiovasculaire, CHU de Saint-Etienne, Saint-Etienne, France
| | | | - Claude Kouakam
- Unité de Rythmologie, Hôpital Cardiologique, CHU de Lille, Lille, France
| | - Romain Eschalier
- Département de Cardiologie, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Fabrice Extramiana
- CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Antoine Leenhardt
- CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Haran Burri
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Genève, Suisse
| | | | - Jérôme Taieb
- Service de Cardiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Jérôme Bouet
- Service de Cardiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Mathieu Fauvernier
- Service de Biostatistiques et Bioinformatique, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, Université Lyon 1, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Horia Rosianu
- Department of Cardiology, Niculae Stancioiu Heart Institute, Cluj-Napoca, Romania
| | - Adrien Carabelli
- Service de Rythmologie, Département de Cardiologie, CHU de Grenoble, Grenoble, France
| | - Benjamin Duband
- Département de Cardiologie, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Chevalier
- Service de Rythmologie, Centre National de Référence des Troubles du Rythme Cardiaque Héréditaires de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France & Université de Lyon, Lyon, France
| |
Collapse
|
4
|
Delinière A, Baranchuk A, Bessière F, Defaye P, Marijon E, Le Vavasseur O, Dobreanu D, Scridon A, Da Costa A, Delacrétaz E, Kouakam C, Eschalier R, Extramiana F, Leenhardt A, Burri H, Winum PF, Taieb J, Bouet J, Rosianu H, Chevalier P. Prognostic significance of a low T/R ratio in Brugada syndrome. J Electrocardiol 2020; 63:6-11. [PMID: 33011474 DOI: 10.1016/j.jelectrocard.2020.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/09/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the prognostic value of a low T/R ratio, defined as the amplitude ratio between the T waves and the R waves, in patients (pts) with a spontaneous type-1 Brugada pattern (SBT1). BACKGROUND Abnormalities of myocardial repolarization may play a key role in the initiation of ventricular fibrillation (VF) in Brugada syndrome (BrS). Recent studies have shown that the height of the T waves and the T/R ratio are inversely proportional to sudden cardiac arrest (SCA) risk in early repolarization syndrome and hypertrophic cardiomyopathy. METHODS In an international retrospective study, we reviewed 115 pts. (105 males, 91.3%). 45 had VF and/or SCA (38.7 ± 11.5 years old, all males), while 70 (49.3 ± 12.0 years, 10 women) remained free of ventricular arrhythmia. 6 ECG markers plus the T/R ratio in leads V5 & II were studied. RESULTS The T/R ratio among leads II & V5 was significantly lower in the VF/SCA group (0.24 [0.14; 0.38]vs. 0.34 [0.24; 0.45]; p = 0.006). 44.4% of pts. in the VF/SCA group had a lowest T/R ratio among leads II & V5 ≤ 0.17 compared to 11.4% in the non-VF/SCA group (p < 0.001). In multivariate analysis, a lowest T/R ratio among leads II & V5 ≤ 0.17 was independently associated with VF/SCA (OR 6.10, 95% CI 1.92-19.40; p = 0.002). Type 1 Brugada pattern in the peripheral leads (OR 10.78) and early repolarization (OR 3.60) were other independent markers of VF/SCA. CONCLUSION A low T/R ratio among leads II & V5 is an independent marker for VF/SCA risk in patients with type-1 Brugada pattern.
Collapse
Affiliation(s)
- Antoine Delinière
- Service de Rythmologie, Centre de Référence National des Troubles du Rythme Cardiaque d'Origine Héréditaire de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France; Université de Lyon, Lyon, France
| | | | - Francis Bessière
- Service de Rythmologie, Centre de Référence National des Troubles du Rythme Cardiaque d'Origine Héréditaire de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France; Université de Lyon, Lyon, France
| | - Pascal Defaye
- Service de Rythmologie, Département de Cardiologie, CHU de Grenoble, Grenoble, France
| | - Eloi Marijon
- Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Dan Dobreanu
- University of Medicine and Pharmacy of Târgu Mureș, Physiology Department, Târgu Mureș, Romania
| | - Alina Scridon
- University of Medicine and Pharmacy of Târgu Mureș, Physiology Department, Târgu Mureș, Romania
| | - Antoine Da Costa
- Pôle Cardiovasculaire, CHU de Saint-Etienne, Saint-Etienne, France
| | | | - Claude Kouakam
- Unité de Rythmologie, Hôpital Cardiologique, CHU de Lille, Lille, France
| | - Romain Eschalier
- Département de Cardiologie, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Fabrice Extramiana
- CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Antoine Leenhardt
- CNMR, Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Haran Burri
- Service de Cardiologie, Hôpitaux Universitaires de Genève, Genève, Suisse, Switzerland
| | | | - Jérôme Taieb
- Service de Cardiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Jérôme Bouet
- Service de Cardiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | - Horia Rosianu
- Department of Cardiology, Niculae Stancioiu Heart Institute, Cluj-Napoca, Romania
| | - Philippe Chevalier
- Service de Rythmologie, Centre de Référence National des Troubles du Rythme Cardiaque d'Origine Héréditaire de Lyon, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Avenue du Doyen Jean Lépine, 69500 Bron, France; Université de Lyon, Lyon, France.
| |
Collapse
|
5
|
Hayashi H, Sumiyoshi M, Nakazato Y, Daida H. Brugada syndrome and sinus node dysfunction. J Arrhythm 2018; 34:216-221. [PMID: 29951135 PMCID: PMC6009769 DOI: 10.1002/joa3.12046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/12/2018] [Indexed: 12/19/2022] Open
Abstract
Brugada syndrome (BrS) is a well-known catastrophic disease first reported in 1992 by the Brugada brothers. Ventricular fibrillation (VF) is an essential arrhythmia in BrS. An association between BrS and atrial tachyarrhythmias is not uncommon. However, sinus node dysfunction (SND) associated with BrS has not been well discussed. In this review, we focus on the association between BrS and SND. Based on previous reports describing clinical, epidemiological, and genetic evidence, SND is not a rare concomitant disorder in BrS. BrS may be a multiple conduction or arrhythmogenic disorder including not only the His-Purkinje system and right ventricle, but also the sinus node and atrium, derived from ion channel mutations.
Collapse
Affiliation(s)
- Hidemori Hayashi
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
| | | | - Yuji Nakazato
- Department of CardiologyJuntendo University Urayasu HospitalUrayasuJapan
| | - Hiroyuki Daida
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
| |
Collapse
|
6
|
Martini B, Martini N, Dorantes Sánchez M, Márquez MF, Zhang L, Fontaine G, Nava A. [Clues of an underlying organic substrate in the Brugada Syndrome]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2016; 87:49-60. [PMID: 28038951 DOI: 10.1016/j.acmx.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/06/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022] Open
Affiliation(s)
- Bortolo Martini
- Unidad Cardiovascular, Hospital Alto Vicentino, Santorso, Italia.
| | - Nicolò Martini
- Colegio Médico, Universidad de Medicina de Ferrara, Ferrara, Italia
| | - Margarita Dorantes Sánchez
- Servicio de Arritmias y Estimulación Cardiaca, Instituto de Cardiología y Cirugía Cardiovascular, La Habana, Cuba
| | - Manlio F Márquez
- Servicio de Electrocardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Li Zhang
- Instituto Lankenau de Investigación Médica, Colegio Médico Jefferson, Filadelfia, Estados Unidos
| | - Guy Fontaine
- Unidad de Ritmología, Instituto de Cardiología, Hospital de La Pitié-Salpêtrière, París, Francia
| | | |
Collapse
|
7
|
Chen Z, Mu J, Chen X, Dong H. Sudden Unexplained Nocturnal Death Syndrome in Central China (Hubei): A 16-Year Retrospective Study of Autopsy Cases. Medicine (Baltimore) 2016; 95:e2882. [PMID: 26945374 PMCID: PMC4782858 DOI: 10.1097/md.0000000000002882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
A retrospective study was conducted at Tongji Forensic Medical Center in Hubei (TFMCH) from 1999 to 2014. Forty-nine cases of sudden unexplained nocturnal death syndrome (SUNDS) were collected. The SUNDS rate was 1.0% in the total number of cases, in which an incidence was fluctuating over the years. Interestingly, April and January, and 3:00 to 6:00 AM were the peak months and times of death. Among the decedents, farmers and migrant workers accounted for 67.3%. The syndrome predominantly attacked males in their 30s. One victim had sinus tachycardia. Thirteen victims (26.5%) were witnessed and had abnormal symptoms near death. Macroscopically, compared to sudden noncardiac deaths, the weights of brain, heart, and lungs had no statistical difference in SUNDS. Microscopically, the incidence of lung edema (45 cases, 91.8%) was significantly higher in SUNDS group than in the control group (27 cases, 55.1%). 82.9% of 35 SUNDS cases examined displayed minor histological anomalies of the cardiac conduction system (CCS), including mild or moderate fatty, fibrous or fibrofatty tissue replacement, insignificant stenosis of node artery, and punctate hemorrhage in the node area. These findings suggested that minor CCS abnormalities might be the substrates for some SUNDS deaths. Therefore, SUNDS victims might suffer ventricular fibrillation and acute cardiopulmonary failure before death. Further in-depth studies are needed to unveil the underlying mechanisms of SUNDS.
Collapse
Affiliation(s)
- Zhenglian Chen
- From the Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan (ZC, XC, HD), and Department of Pathology, HeBei North University, Zhangjiakou, Hebei (JM), P.R. China
| | | | | | | |
Collapse
|
8
|
Sinus node disease in subjects with type 1 ECG pattern of Brugada syndrome. J Cardiol 2013; 61:227-31. [PMID: 23403368 DOI: 10.1016/j.jjcc.2012.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 11/22/2012] [Accepted: 12/04/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND The spectrum of phenotypes related to mutations of the SCN5A gene include Brugada syndrome (BS), long QT syndrome, progressive cardiac conduction defect, and sinus node disease (SND). The present study investigated the incidence of SND in subjects with type 1 electrocardiogram (ECG) pattern of BS. METHODS AND RESULTS The study population consisted of 68 individuals (55 males, mean age 44.8±12.8 years) with spontaneous (n=27) or drug-induced (n=41) type 1 ECG pattern of BS. Twenty-eight subjects were symptomatic with a history of syncope (41.2%). SND was observed in 6 symptomatic subjects (8.8%), and was mainly attributed to sino-atrial block with sinus pauses. Two patients were initially diagnosed with SND, and received a pacemaker. Patients with SND displayed an increased P-wave duration in leads II and V2, PR interval in leads II and V2, QRS duration in leads II and V2, and increased QTc interval in lead V2 (p<0.05). AH and HV intervals as well as corrected sinus node recovery time (cSNRT) were significantly prolonged in subjects with SND (p<0.05). During a mean follow-up period of 5.0±3.6 years, five subjects with a history of syncope suffered appropriate implantable cardioverter defibrillator (ICD) discharges due to ventricular arrhythmias (7.4%). None of those diagnosed with SND suffered syncope or ICD therapies. CONCLUSION SND is not an uncommon finding in subjects with type 1 ECG pattern of BS. The occurrence of SND in relatively young patients may deserve meticulous investigation including sodium channel blocking test.
Collapse
|
9
|
Cohle SD. Histopathology of the Cardiac Conduction System in the Investigation of Sudden Unexpected Death. Acad Forensic Pathol 2011. [DOI: 10.23907/2011.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
When a gross and microscopic autopsy, drug screen, and past medical history fail to yield a cause of death, the forensic pathologist may opt to study the cardiac conduction system. This paper describes the excision of the SA (sinoatrial) node and AV(atrioventricular) node-containing areas of the heart and the microscopic appearance of normal SA and AV nodes, His bundle and bundle branches. Conduction system findings that have been reported to be significant include fibromuscular hyperplasia (often mislabeled dysplasia) of the SA and AV nodes arteries, persistent fetal dispersion of the AV node and His bundle, accessory pathways, ganglionitis and neuritis near the SA node, fibrosis and fatty infiltration of the conducting tissue, AV node tumor, left-sided His bundle, and AV node fibrosis. In an otherwise normal autopsy, AV node tumors, severe fibromuscular hyperplasia of the AV node artery and AV node fibrosis are sufficient to cause death. Other findings, particularly Mahaim tracks, are competent causes of death if they correlate with premortem electrocardiographic findings. Conduction system examination, although a low-yield procedure, is a worthwhile endeavor. Care must be taken to not overestimate the significance of the findings.
Collapse
|
10
|
Ohkubo K, Watanabe I, Okumura Y, Takagi Y, Ashino S, Kofune M, Sugimura H, Nakai T, Kasamaki Y, Hirayama A, Morimoto SI. Right ventricular histological substrate and conduction delay in patients with Brugada syndrome. Int Heart J 2010; 51:17-23. [PMID: 20145346 DOI: 10.1536/ihj.51.17] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The reported pathogenesis of Brugada syndrome is phase 2 reentry resulting from shortening of the epicardial action potential duration at the right ventricular outflow tract (RVOT). However, several studies have revealed a high incidence of ventricular late potentials and high rate of ventricular fibrillation (VF) induced by programmed ventricular stimulation (PVS). The aim of the present study was to evaluate the role of slow conduction at the RVOT for the initiation of VF by PVS and any underlying pathological conditions in Brugada syndrome. Endocardial mapping of the RVOT and endomyocardial biopsy of the right ventricle were performed in 25 patients with Brugada syndrome with inducible VF. Late potentials were positive in 11 of the 25 (44%) patients. Low-amplitude fragmented and delayed electrograms were recorded at the RVOT in 13 of 18 (72.2%) patients. Histologic examination of the biopsy samples revealed fatty tissue infiltration, interstitial fibrosis, lymphocyte infiltration, and/or myocyte disorganization in 13 patients. Slow conduction at the RVOT may contribute to the induction of VF by PVS in Brugada syndrome. Various pathomorphologic changes may contribute to slow conduction at the RVOT.
Collapse
Affiliation(s)
- Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Hayashi H, Sumiyoshi M, Yasuda M, Komatsu K, Sekita G, Kawano Y, Tokano T, Nakazato Y, Daida H. Prevalence of the Brugada-Type Electrocardiogram and Incidence of Brugada Syndrome in Patients With Sick Sinus Syndrome. Circ J 2010; 74:271-7. [DOI: 10.1253/circj.cj-09-0455] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hidemori Hayashi
- Department of Cardiology, Juntendo University School of Medicine
| | | | - Masayuki Yasuda
- Department of Cardiology, Juntendo University School of Medicine
| | - Kaoru Komatsu
- Department of Cardiology, Juntendo University School of Medicine
| | - Gaku Sekita
- Department of Cardiology, Juntendo University School of Medicine
| | - Yasunobu Kawano
- Department of Cardiology, Juntendo University Urayasu Hospital
| | - Takashi Tokano
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Yuji Nakazato
- Department of Cardiology, Juntendo University Urayasu Hospital
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine
| |
Collapse
|
12
|
Marras E, Basso C, Sciarra L, Delise P. Unexplained syncope, Brugada-like ECG and minimal structural right ventricular abnormalities: which is the right diagnosis? J Cardiovasc Med (Hagerstown) 2009; 10:273-5. [DOI: 10.2459/jcm.0b013e328322fc09] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
13
|
Fazelifar AF, Haghjoo M, Emkanjoo Z, Alizadeh A, Alasti M, Peighambari M, Sadr-Ameli MA. Brugada-Type ECG Association with Unexpected Sick Sinus Syndrome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:204-6. [PMID: 16492310 DOI: 10.1111/j.1540-8159.2006.00319.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 23-year-old man was referred to our center for atrial flutter ablation. After arrhythmia termination sinus node dysfunction unmasked and persisted after 2 months drug-free follow-up. Secondary causes such as antiarrhythmic drug consumption, organic heart disease, or electrolyte disturbance could be excluded. Standard 12-lead ECG showed a coved-type ST elevation in V1-V3, which increased after flecainide provocative test. Following an unexpected sick sinus syndrome, a Brugada-type ECG should be noted.
Collapse
Affiliation(s)
- Amir Farjam Fazelifar
- Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | | | | | | | | | | | | |
Collapse
|