1
|
Seghetti P, Latrofa S, Biasi N, Giannoni A, Hartwig V, Rossi A, Tognetti A. Electrophysiological patterns and structural substrates of Brugada syndrome: Critical appraisal and computational analyses. J Cardiovasc Electrophysiol 2024; 35:1673-1687. [PMID: 38899376 DOI: 10.1111/jce.16341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/24/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024]
Abstract
Brugada syndrome (BrS) is a cardiac electrophysiological disease with unknown etiology, associated with sudden cardiac death. Symptomatic patients are treated with implanted cardiac defibrillator, but no risk stratification strategy is effective in patients that are at low to medium arrhythmic risk. Cardiac computational modeling is an emerging tool that can be used to verify the hypotheses of pathogenesis and inspire new risk stratification strategies. However, to obtain reliable results computational models must be validated with consistent experimental data. We reviewed the main electrophysiological and structural variables from BrS clinical studies to assess which data could be used to validate a computational approach. Activation delay in the epicardial right ventricular outflow tract is a consistent finding, as well as increased fibrosis and subclinical alterations of right ventricular functional and morphological parameters. The comparison between other electrophysiological variables is hindered by methodological differences between studies, which we commented. We conclude by presenting a recent theory unifying electrophysiological and structural substrate in BrS and illustrate how computational modeling could help translation to risk stratification.
Collapse
Affiliation(s)
- Paolo Seghetti
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Sara Latrofa
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Niccolò Biasi
- Department of Information Engineering, Università di Pisa, Pisa, Italy
| | - Alberto Giannoni
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana 'G. Monasterio', Pisa, Italy
| | - Valentina Hartwig
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
- Fondazione Toscana 'G. Monasterio', Pisa, Italy
| | | | - Alessandro Tognetti
- Department of Information Engineering, Università di Pisa, Pisa, Italy
- Research Center 'Enrico Piaggio', Università di Pisa, Pisa, Italy
| |
Collapse
|
2
|
Lu YY, Chen YC, Lin YK, Chen SA, Chen YJ. Electrical and Structural Insights into Right Ventricular Outflow Tract Arrhythmogenesis. Int J Mol Sci 2023; 24:11795. [PMID: 37511554 PMCID: PMC10380666 DOI: 10.3390/ijms241411795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/08/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
The right ventricular outflow tract (RVOT) is the major origin of ventricular arrhythmias, including premature ventricular contractions, idiopathic ventricular arrhythmias, Brugada syndrome, torsade de pointes, long QT syndrome, and arrhythmogenic right ventricular cardiomyopathy. The RVOT has distinct developmental origins and cellular characteristics and a complex myocardial architecture with high shear wall stress, which may lead to its high vulnerability to arrhythmogenesis. RVOT myocytes are vulnerable to intracellular sodium and calcium overload due to calcium handling protein modulation, enhanced CaMKII activity, ryanodine receptor phosphorylation, and a higher cAMP level activated by predisposing factors or pathological conditions. A reduction in Cx43 and Scn5a expression may lead to electrical uncoupling in RVOT. The purpose of this review is to update the current understanding of the cellular and molecular mechanisms of RVOT arrhythmogenesis.
Collapse
Affiliation(s)
- Yen-Yu Lu
- Division of Cardiology, Department of Internal Medicine, Sijhih Cathay General Hospital, New Taipei City 22174, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City 24257, Taiwan
| | - Yao-Chang Chen
- Department of Biomedical Engineering, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yung-Kuo Lin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Cardiovacular Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Yi-Jen Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Cardiovacular Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11696, Taiwan
| |
Collapse
|
3
|
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
|
4
|
Chung CT, Bazoukis G, Radford D, Coakley-Youngs E, Rajan R, Matusik PT, Liu T, Letsas K, Lee S, Tse G. Predictive risk models for forecasting arrhythmic outcomes in Brugada syndrome: A focused review. J Electrocardiol 2022; 72:28-34. [PMID: 35287003 DOI: 10.1016/j.jelectrocard.2022.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/19/2022] [Accepted: 02/20/2022] [Indexed: 12/20/2022]
|
5
|
Korkosh VS, Zaytseva AK, Kostareva AA, Zhorov BS. Intersegment Contacts of Potentially Damaging Variants of Cardiac Sodium Channel. Front Pharmacol 2021; 12:756415. [PMID: 34803699 PMCID: PMC8600069 DOI: 10.3389/fphar.2021.756415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022] Open
Abstract
Over 1,500 missense variants of sodium channel hNav1.5, which are reported in the ClinVar database, are associated with cardiac diseases. For most of the variants, the clinical significance is uncertain (VUS), not provided (NP), or has conflicting interpretations of pathogenicity (CIP). Reclassifying these variants as pathogenic/likely pathogenic (P/LP) variants is important for diagnosing genotyped patients. In our earlier work, several bioinformatics tools and paralogue annotation method consensually predicted that 74 VUS/NP/CIP variants of 54 wild type residues (set w54) are potentially damaging variants (PDVs). Atomic mechanisms underlying dysfunction of the PDVs are unknown. Here we employed a recent cryo-EM structure of the hNav1.5 channel with likely inactivated pore domain (PD) and activated voltage-sensing domains (VSDs), and ad hoc models of the closed and open PD and resting VSDs to explore intersegment contacts of w54 residues. We found that 44 residues from set w54 contact 84 residues with 118 disease missense variants. These include 104 VUS/NP/CIP variants, most of which are associated with the loss-of-function Brugada syndrome (BrS1) or gain-of-function long QT syndrome (LQT3). Matrix representation of the PDVs and their contact variants facilitated recognition of coupled mutations associated with the same disease. In particular, BrS1-associated coupled mutations, which disturb the P-loops region with the selectivity filter slow inactivation gate, would cause the channel dysfunction. Other likely causes of the channel dysfunction include coupled BrS1-associated variants within VSDs that would destabilize their activated states and coupled LQT3-associated variants, which would stabilize the open PD or activated VSDs. Our study proposes mechanisms of channel dysfunction for scores of BrS1- and LQT3-associated variants, confirms status for 82% of PDVs, and suggests damaging status for their contact variants, which are currently categorized as VUS/NP/CIP variants.
Collapse
Affiliation(s)
- Vyacheslav S Korkosh
- Almazov National Medical Research Centre, St. Petersburg, Russia.,Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Anastasia K Zaytseva
- Almazov National Medical Research Centre, St. Petersburg, Russia.,Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Anna A Kostareva
- Almazov National Medical Research Centre, St. Petersburg, Russia.,Department of Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Boris S Zhorov
- Almazov National Medical Research Centre, St. Petersburg, Russia.,Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia.,Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
6
|
Chaumont C, Suffee N, Gandjbakhch E, Balse E, Anselme F, Hatem SN. Epicardial origin of cardiac arrhythmias: clinical evidences and pathophysiology. Cardiovasc Res 2021; 118:1693-1702. [PMID: 34152392 PMCID: PMC9215195 DOI: 10.1093/cvr/cvab213] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
Recent developments in imaging, mapping, and ablation techniques have shown that the epicardial region of the heart is a key player in the occurrence of ventricular arrhythmic events in several cardiac diseases, such as Brugada syndrome, arrhythmogenic cardiomyopathy, or dilated cardiomyopathy. At the atrial level as well, the epicardial region has emerged as an important determinant of the substrate of atrial fibrillation, pointing to common underlying pathophysiological mechanisms. Alteration in the gradient of repolarization between myocardial layers favouring the occurrence of re-entry circuits has largely been described. The fibro-fatty infiltration of the subepicardium is another shared substrate between ventricular and atrial arrhythmias. Recent data have emphasized the role of the epicardial reactivation in the formation of this arrhythmogenic substrate. There are new evidences supporting this structural remodelling process to be regulated by the recruitment of epicardial progenitor cells that can differentiate into adipocytes or fibroblasts under various stimuli. In addition, immune-inflammatory processes can also contribute to fibrosis of the subepicardial layer. A better understanding of such ‘electrical fragility’ of the epicardial area will open perspectives for novel biomarkers and therapeutic strategies. In this review article, a pathophysiological scheme of epicardial-driven arrhythmias will be proposed.
Collapse
Affiliation(s)
- Corentin Chaumont
- Cardiology Department, Rouen University Hospital, Rouen, France.,FHU REMOD-VHF, UNIROUEN, INSERM U1096, F76000, France
| | - Nadine Suffee
- INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Estelle Gandjbakhch
- INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Elise Balse
- INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Frédéric Anselme
- Cardiology Department, Rouen University Hospital, Rouen, France.,FHU REMOD-VHF, UNIROUEN, INSERM U1096, F76000, France
| | - Stéphane N Hatem
- INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| |
Collapse
|
7
|
iPSC-Cardiomyocyte Models of Brugada Syndrome-Achievements, Challenges and Future Perspectives. Int J Mol Sci 2021; 22:ijms22062825. [PMID: 33802229 PMCID: PMC8001521 DOI: 10.3390/ijms22062825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/19/2022] Open
Abstract
Brugada syndrome (BrS) is an inherited cardiac arrhythmia that predisposes to ventricular fibrillation and sudden cardiac death. It originates from oligogenic alterations that affect cardiac ion channels or their accessory proteins. The main hurdle for the study of the functional effects of those variants is the need for a specific model that mimics the complex environment of human cardiomyocytes. Traditionally, animal models or transient heterologous expression systems are applied for electrophysiological investigations, each of these models having their limitations. The ability to create induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs), providing a source of human patient-specific cells, offers new opportunities in the field of cardiac disease modelling. Contemporary iPSC-CMs constitute the best possible in vitro model to study complex cardiac arrhythmia syndromes such as BrS. To date, thirteen reports on iPSC-CM models for BrS have been published and with this review we provide an overview of the current findings, with a focus on the electrophysiological parameters. We also discuss the methods that are used for cell derivation and data acquisition. In the end, we critically evaluate the knowledge gained by the use of these iPSC-CM models and discuss challenges and future perspectives for iPSC-CMs in the study of BrS and other arrhythmias.
Collapse
|
8
|
Abstract
The Brugada syndrome is an inherited channelopathy that alters the main transmembrane ion currents that constitute the cardiac action potential. These changes not only modify the resting electrocardiogram but also predispose patients to develop malignant ventricular tachyarrhythmias that can lead to syncope, cardiac arrest, and sudden cardiac death. This syndrome is responsible for nearly 20% of all sudden cardiac deaths in patients with structurally normal hearts and up to 12% of all sudden cardiac deaths. Brugada syndrome is diagnosed by its characteristic electrocardiogram consisting of a coved-type ST-segment elevation of at least 2 mm followed by a negative T wave in either one of the right precordial leads. These changes can be observed spontaneously or after administration of a sodium channel blocker. While our understanding of this disease has increased tremendously since its first description in 1992, the primary therapeutic option remains implantation of an implantable cardioverter-defibrillator to avoid sudden cardiac death. Therefore, tremendous effort is being made to effectively risk stratify patients to determine who would benefit from implantable cardioverter-defibrillator implantation.
Collapse
|
9
|
Campbell T, Bennett RG, Kotake Y, Kumar S. Updates in Ventricular Tachycardia Ablation. Korean Circ J 2021; 51:15-42. [PMID: 33377327 PMCID: PMC7779814 DOI: 10.4070/kcj.2020.0436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023] Open
Abstract
Sudden cardiac death (SCD) due to recurrent ventricular tachycardia is an important clinical sequela in patients with structural heart disease. As a result, ventricular tachycardia (VT) has emerged as a major clinical and public health problem. The mechanism of VT is predominantly mediated by re-entry in the presence of arrhythmogenic substrate (scar), though focal mechanisms are also important. Catheter ablation for VT, when compared to standard medical therapy, has been shown to improve VT-free survival and burden of device therapies. Approaches to VT ablation are dependent on the underlying disease process, broadly classified into idiopathic (no structural heart disease) or structural heart disease (ischemic or non-ischemic heart disease). This update aims to review recent advances made for the treatment of VT ablation, with respect to current clinical trials, peri-procedure risk assessments, pre-procedural cardiac imaging, electro-anatomic mapping and advances in catheter and non-catheter based ablation techniques.
Collapse
Affiliation(s)
- Timothy Campbell
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Yasuhito Kotake
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, University of Sydney, New South Wales, Australia.
| |
Collapse
|
10
|
Inherited Cardiac Arrhythmia Syndromes: Focus on Molecular Mechanisms Underlying TRPM4 Channelopathies. Cardiovasc Ther 2020; 2020:6615038. [PMID: 33381229 PMCID: PMC7759408 DOI: 10.1155/2020/6615038] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022] Open
Abstract
The Transient Receptor Potential Melastatin 4 (TRPM4) is a transmembrane N-glycosylated ion channel that belongs to the large family of TRP proteins. It has an equal permeability to Na+ and K+ and is activated via an increase of the intracellular calcium concentration and membrane depolarization. Due to its wide distribution, TRPM4 dysfunction has been linked with several pathophysiological processes, including inherited cardiac arrhythmias. Many pathogenic variants of the TRPM4 gene have been identified in patients with different forms of cardiac disorders such as conduction defects, Brugada syndrome, and congenital long QT syndrome. At the cellular level, these variants induce either gain- or loss-of-function of TRPM4 channels for similar clinical phenotypes. However, the molecular mechanisms associating these functional alterations to the clinical phenotypes remain poorly understood. The main objective of this article is to review the major cardiac TRPM4 channelopathies and recent advances regarding their genetic background and the underlying molecular mechanisms.
Collapse
|
11
|
Electromechanical delay by speckle-tracking echocardiography: A novel tool to distinguish between Brugada syndrome and isolated right bundle branch block. Int J Cardiol 2020; 320:161-167. [DOI: 10.1016/j.ijcard.2020.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022]
|
12
|
Electrocardiographic imaging (ECGI): What is the minimal number of leads needed to obtain a good spatial resolution? J Electrocardiol 2020; 62:86-93. [PMID: 32835985 DOI: 10.1016/j.jelectrocard.2020.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/11/2020] [Accepted: 07/17/2020] [Indexed: 11/22/2022]
Abstract
AIMS Assess the minimal number of ECGI leads needed to obtain a good spatial resolution. METHODS We enrolled 20 patients that underwent ablation of premature ventricular or atrial contractions using Carto and ECGI with AMYCARD. We evaluated the agreement regarding the site of origin of the arrhythmia between the ECGI and Carto, the area and diameter of the earliest activation site obtained with the ECGI (EASa and EASd). Based on previous studies with pacemapping, we considered a good spatial resolution of the ECGI when the EASd measured on the isopotential map was less than 18 mm. In presence of agreement the ECGI was reprocessed: a) with half the number of electrode bands (8 leads per electrode band) and b) with 6 electrode bands. RESULTS The initial map was obtained with 23 (22-23) electrode bands per patient, corresponding to 143 (130-170) leads. Agreement rate was 85%, the median EASa and EASd were: 0.7 (0.5-1.3) cm2 and 9 (8-13) mm. With half the number of electrode bands including 73 (60-79) leads, agreement rate was 80%, the EASa and EASd were: 2.1 (1.5-6.2) cm2 and 16 (14 -28) mm. With only six electrode bands using 38 (30-42) leads, agreement rate was 55%, EASa and EASd were: 4.0 (3.3-5.0) cm2 and 23 (21-25) mm. The number of leads was a predictor of agreement with a good spatial resolution, OR (95% CI) of 1.138 (1.050-1.234), p = .002. According to the ROC curve, the minimal number of leads was 74 (AUC 0.981; 95% CI: 0.949-1.00, p < .0001). CONCLUSION Reducing the number of leads was associated with a lower agreement rate and a significant reduction of spatial resolution. However, the number of leads needed to achieve a good spatial resolution was less than the maximal available.
Collapse
|
13
|
Galli A, Rizzo A, Monaco C, Salghetti F, Scala O, Chierchia GB, La Meir M, Brugada P, de Asmundis C. Electrocardiographic imaging of the arrhythmogenic substrate of Brugada syndrome: Current evidence and future perspectives. Trends Cardiovasc Med 2020; 31:323-329. [PMID: 32553882 DOI: 10.1016/j.tcm.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/26/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
Brugada syndrome is responsible for about 20% of sudden cardiac deaths in patients with apparently normal hearts. Basic and clinical research has elucidated some of the mechanisms that are responsible for life-threatening ventricular arrhythmias in this syndrome. Delays in activation and repolarization over the right ventricular outflow tract are the most likely cause of the ECG typical pattern and arrhythmogenesis. Invasive epicardial and endocardial mapping has identified the epicardium as the principal region of interest for these anomalies, and areas of fragmented potentials at invasive mapping are a target for epicardial ablation. Noninvasive mapping systems have been developed to study the epicardial depolarization and repolarization and may be particularly useful in assessing the epicardial arrhythmogenic substrate of Brugada syndrome for both clinical and research purpose. This review focuses on recent advances in this field.
Collapse
Affiliation(s)
- Alessio Galli
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Belgium
| | - Alessandro Rizzo
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Belgium
| | - Francesca Salghetti
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Belgium
| | - Oriana Scala
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Belgium
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Belgium.
| |
Collapse
|
14
|
Brugada J, Campuzano O, Arbelo E, Sarquella-Brugada G, Brugada R. Present Status of Brugada Syndrome: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 72:1046-1059. [PMID: 30139433 DOI: 10.1016/j.jacc.2018.06.037] [Citation(s) in RCA: 251] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 01/04/2023]
Abstract
The Brugada syndrome is an inherited disorder associated with risk of ventricular fibrillation and sudden cardiac death in a structurally normal heart. Diagnosis is based on a characteristic electrocardiographic pattern (coved type ST-segment elevation ≥2 mm followed by a negative T-wave in ≥1 of the right precordial leads V1 to V2), observed either spontaneously or during a sodium-channel blocker test. The prevalence varies among regions and ethnicities, affecting mostly males. The risk stratification and management of patients, principally asymptomatic, still remains challenging. The current main therapy is an implantable cardioverter-defibrillator, but radiofrequency catheter ablation has been recently reported as an effective new treatment. Since its first description in 1992, continuous achievements have expanded our understanding of the genetics basis and electrophysiological mechanisms underlying the disease. Currently, despite several genes identified, SCN5A has attracted most attention, and in approximately 30% of patients, a genetic variant may be implicated in causation after a comprehensive analysis.
Collapse
Affiliation(s)
- Josep Brugada
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - Oscar Campuzano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiovascular Genetics Center, Institut d'Investigació Biomèdica Girona (IDIBGI), University of Girona, Girona, Spain; Medical Science Department, School of Medicine, University of Girona, Girona, Spain
| | - Elena Arbelo
- Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Georgia Sarquella-Brugada
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Medical Science Department, School of Medicine, University of Girona, Girona, Spain
| | - Ramon Brugada
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Cardiovascular Genetics Center, Institut d'Investigació Biomèdica Girona (IDIBGI), University of Girona, Girona, Spain; Medical Science Department, School of Medicine, University of Girona, Girona, Spain; Cardiology Service, Hospital Josep Trueta, Girona, Spain
| |
Collapse
|
15
|
Parreira L, Carmo P, Adragão P, Pinho J, Budanova M, Zubarev S, Cavaco D, Marinheiro R, Carmo J, Costa F, Marques H, Goncalves P. Non-invasive electrocardiographic imaging in patients with idiopathic premature ventricular contractions from the right ventricular outflow tract: New insights into arrhythmia substrate. J Electrocardiol 2019; 57:69-76. [PMID: 31514015 DOI: 10.1016/j.jelectrocard.2019.08.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/19/2019] [Accepted: 08/30/2019] [Indexed: 11/17/2022]
Abstract
AIMS The aim of this study was to use non-invasive electrocardiographic imaging (ECGI) to study the electrophysiological properties of right ventricular outflow tract (RVOT) in patients with frequent premature ventricular contractions (PVCs) from the RVOT and in controls. METHODS ECGI is a combined application of body surface electrocardiograms and computed tomography or magnetic resonance imaging data. Unipolar electrograms are reconstructed on the epicardial and endocardial surfaces. Activation time (AT) was defined as the time of maximal negative slope of the electrogram (EGM) during QRS, recovery time (RT) as the time of maximal positive slope of the EGM during T wave, Activation recovery interval (ARI) was defined as the difference between RT and AT. ARI dispersion (Δ ARI) and RT dispersion (Δ RT) were calculated as the difference between maximal and minimal ARI and RT respectively. We evaluated those parameters in patients with frequent PVCs from the RVOT, defined as >10.000 per 24 h, and in a control group. RESULTS We studied 7 patients with frequent RVOT PVCs and 17 controls. Patients with PVCs from the RVOT had shorter median RT than controls, in the endocardium and in the epicardium, respectively 380 (239-397) vs 414 (372-448) ms, p = 0.047 and 275 (236-301) vs 330 (263-418) ms, p = 0.047. The dispersion of ARI and of RT in the epicardium was higher than in controls, Δ ARI of 145 (68-216) vs 17 (3-48) ms, p = 0.001 and Δ RT of 201 (160-235) vs 115 (65-177), p = 0.019. CONCLUSION In this group of patients we found a shorter median RT in the endocardium and in the epicardium of the RVOT and a higher dispersion of the ARI and RT across the epicardium in patients with PVCs from the RVOT when comparing to controls.
Collapse
Affiliation(s)
| | - Pedro Carmo
- Hospital Luz Lisboa, Av Lusiada 1500-650, Lisboa, Portugal
| | - Pedro Adragão
- Hospital Luz Lisboa, Av Lusiada 1500-650, Lisboa, Portugal
| | - Joana Pinho
- Hospital Luz Lisboa, Av Lusiada 1500-650, Lisboa, Portugal
| | | | - Stepan Zubarev
- Hospital Luz Lisboa, Av Lusiada 1500-650, Lisboa, Portugal
| | - Diogo Cavaco
- Hospital Luz Lisboa, Av Lusiada 1500-650, Lisboa, Portugal
| | | | - João Carmo
- Hospital Luz Lisboa, Av Lusiada 1500-650, Lisboa, Portugal
| | | | - Hugo Marques
- Hospital Luz Lisboa, Av Lusiada 1500-650, Lisboa, Portugal
| | | |
Collapse
|
16
|
Kalinin A, Potyagaylo D, Kalinin V. Solving the Inverse Problem of Electrocardiography on the Endocardium Using a Single Layer Source. Front Physiol 2019; 10:58. [PMID: 30804802 PMCID: PMC6370732 DOI: 10.3389/fphys.2019.00058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/18/2019] [Indexed: 12/04/2022] Open
Abstract
The inverse problem of electrocardiography consists in reconstructing cardiac electrical activity from given body surface electrocardiographic measurements. Despite tremendous progress in the field over the last decades, the solution of this problem in terms of electrical potentials on both epi- and the endocardial heart surfaces with acceptable accuracy remains challenging. This paper presents a novel numerical approach aimed at improving the solution quality on the endocardium. Our method exploits the solution representation in the form of electrical single layer densities on the myocardial surface. We demonstrate that this representation brings twofold benefits: first, the inverse problem can be solved for the physiologically meaningful single layer densities. Secondly, a conventional transfer matrix for electrical potentials can be split into two parts, one of which turned out to posess regularizing properties leading to improved endocardial reconstructions. The method was tested in-silico for ventricular pacings utilizing realistic CT-based heart and torso geometries. The proposed approach provided more accurate solution on the ventricular endocardium compared to the conventional potential-based solutions with Tikhonov regularization of the 0th, 1st, and 2nd orders. Furthermore, we show a uniform spatio-temporal behavior of the single layer densities over the heart surface, which could be conveniently employed in the regularization procedure.
Collapse
|
17
|
Zhou S, Sapp JL, Stovicek P, Horacek BM. Localization of Activation Origin on Patient-Specific Endocardial Surface by the Equivalent Double Layer (EDL) Source Model With Sparse Bayesian Learning. IEEE Trans Biomed Eng 2018; 66:2287-2295. [PMID: 30571613 DOI: 10.1109/tbme.2018.2887041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Ablation treatment of ventricular arrhythmias can be facilitated by pre-procedure planning aided by electrocardiographic inverse solution, which can help to localize the origin of arrhythmia. Our aim was to improve localization accuracy of the inverse solution for activation originating on the left-ventricular endocardial surface, by using a sparse Bayesian learning (SBL). METHODS The inverse problem of electrocardiography was solved by reconstructing endocardial potentials from time integrals of body-surface electrocardiograms and from patient-specific geometry of the heart and torso for three patients with structurally normal ventricular myocardium, who underwent endocardial catheter mapping that included pace mapping. Complementary simulations using dipole sources in patient-specific geometry were also performed. The proposed method is using sparse property of the equivalent-double-layer (EDL) model of cardiac sources; it employs the SBL and makes use of the spatio-temporal features of the cardiac action potentials. RESULTS The mean localization error of the proposed method for pooled pacing sites ( n=52) was significantly smaller ( p=0.0039) than that achieved for the same patients in the study of Erem et al. Simulation experiments localized the source dipoles ( n=48) from forward-simulated potentials with the error of 9.4 ± 4.5 mm (mean ± SD). CONCLUSION The results of our clinical and simulation experiments demonstrate that localization of left-ventricular endocardial activation by means of the Bayesian approach, based on sparse representation of sources by EDL, is feasible and accurate. SIGNIFICANCE The proposed approach to localizing endocardial sources may have important applications in pre-procedure assessment of arrhythmias and in guiding their ablation treatment.
Collapse
|
18
|
Aleong RG, Chandara M. Management of Brugada Syndrome in the Developing Countries. CURRENT CARDIOVASCULAR RISK REPORTS 2018. [DOI: 10.1007/s12170-018-0595-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
19
|
Espinosa Á, Ripollés-Melchor J, Brugada R, Campuzano Ó, Sarquella-Brugada G, Abad-Motos A, Zaballos-García M, Abad-Torrent A, Prieto-Gundin A, Brugada J. Brugada Syndrome: anesthetic considerations and management algorithm. Minerva Anestesiol 2018; 85:173-188. [PMID: 30394071 DOI: 10.23736/s0375-9393.18.13170-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Brugada Syndrome is characterized by arrhythmogenic risk that may be exacerbated by different metabolic and pharmacological factors. Since its first description, knowledge of this syndrome and its detection by physicians belonging to different specialties have gradually increased. The risk of arrhythmias is well known to increase in the postoperative period, and this risk is particularly accentuated in patients with Brugada Syndrome. The purpose of this review is to analyze the relationship between this syndrome and anesthesia; establish recommendations for the safe management of these patients in the surgical setting; and update the relevant concepts regarding the safety of drug administration in individuals with Brugada Syndrome.
Collapse
Affiliation(s)
- Ángel Espinosa
- Department of Cardiothoracic Anesthesia, Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Center, Royal Medical Services, Awali, Bahrain.,Evidence Anesthesia Review Group (EAR), Department of Pharmacology, Faculty of Medicine of Complutense University of Madrid, Madrid, Spain
| | - Javier Ripollés-Melchor
- Evidence Anesthesia Review Group (EAR), Department of Pharmacology, Faculty of Medicine of Complutense University of Madrid, Madrid, Spain - .,Department of Anesthesiology and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Madrid Complutense University, Madrid, Spain.,Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
| | - Ramón Brugada
- Cardiovascular Genetics Center, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Cardiovascular Diseases Network Biomedical Research Center (CIBERCV), Madrid, Spain.,Department of Cardiology, Josep Trueta Hospital, Girona, Spain
| | - Óscar Campuzano
- Cardiovascular Genetics Center, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Cardiovascular Diseases Network Biomedical Research Center (CIBERCV), Madrid, Spain
| | - Georgia Sarquella-Brugada
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Unit of Pediatric Arrhythmia, Department of Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain.,Section of Arrhythmia, Department of Cardiology, Clinic Hospital, University of Barcelona, Barcelona, Spain
| | - Ane Abad-Motos
- Department of Anesthesiology and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Madrid Complutense University, Madrid, Spain.,Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
| | - Matilde Zaballos-García
- Department of Anesthesiology, Gregorio Marañón University General Hospital, Madrid, Spain.,Clinical Toxicology, Madrid Complutense University, Madrid, Spain
| | - Ana Abad-Torrent
- Department of Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandra Prieto-Gundin
- Department of Pediatric Anesthesiology, Sant Joan de Déu Hospital, Barcelona Children's Hospital, Barcelona, Spain
| | - Josep Brugada
- Unit of Pediatric Arrhythmia, Department of Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain.,Section of Arrhythmia, Department of Cardiology, Clinic Hospital, University of Barcelona, Barcelona, Spain
| |
Collapse
|
20
|
Progression of electrocardiographic abnormalities associated with initial ventricular fibrillation in asymptomatic patients with Brugada syndrome. Heart Rhythm 2018; 15:1468-1474. [DOI: 10.1016/j.hrthm.2018.06.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Indexed: 11/21/2022]
|
21
|
Monasky MM, Pappone C, Piccoli M, Ghiroldi A, Micaglio E, Anastasia L. Calcium in Brugada Syndrome: Questions for Future Research. Front Physiol 2018; 9:1088. [PMID: 30147658 PMCID: PMC6095984 DOI: 10.3389/fphys.2018.01088] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/23/2018] [Indexed: 12/11/2022] Open
Abstract
The Brugada syndrome (BrS) is characterized by coved-type ST-segment elevation in the right precordial leads on the electrocardiogram (ECG) and increased risk of sudden cardiac death (SCD). While it is an inheritable disease, determining the true prevalence is a challenge, since patients may report no known family history of the syndrome, present with a normal spontaneous ECG pattern at the time of examination, and test negative for all known BrS-causative genes. In fact, SCD is often the first indication that a person is affected by the syndrome. Men are more likely to be symptomatic than women. Abnormal, low-voltage, fractionated electrograms have been found in the epicardium of the right ventricular outflow tract (RVOT). Ablation of this area abolishes the abnormal electrograms and helps to prevent arrhythmic recurrences. BrS patients are more likely to experience ventricular tachycardia/fibrillation (VT/VF) during fever or during an increase in vagal tone. Isoproterenol helps to reverse the ECG BrS phenotype. In this review, we discuss roles of calcium in various conditions that are relevant to BrS, such as changes in temperature, heart rate, and vagal tone, and the effects of gender and isoproterenol on calcium handling. Studies are warranted to further investigate these mechanisms in models of BrS.
Collapse
Affiliation(s)
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Marco Piccoli
- Stem Cells for Tissue Engineering Lab, IRCCS Policlinico San Donato, Milan, Italy
| | - Andrea Ghiroldi
- Stem Cells for Tissue Engineering Lab, IRCCS Policlinico San Donato, Milan, Italy
| | - Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Luigi Anastasia
- Stem Cells for Tissue Engineering Lab, IRCCS Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| |
Collapse
|
22
|
Relations between right ventricular morphology and clinical, electrical and genetic parameters in Brugada Syndrome. PLoS One 2018; 13:e0195594. [PMID: 29652902 PMCID: PMC5898761 DOI: 10.1371/journal.pone.0195594] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/25/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Increasing evidence suggests the presence of structural changes affecting the right ventricular outflow tract (RVOT) in patients with Brugada Syndrome (BrS). The aim of this study was to characterise the RV morphology in BrS and explore associations between morphologic, clinical, electrical, and genetic parameters using non-invasive multimodality testing. METHODS Consecutive BrS patients (recruited 2013-2015) underwent clinical assessment, dedicated RV imaging using cardiac magnetic resonance (CMR) imaging (unless contra-indicated), electrical assessment (electrocardiogram, Holter monitoring, signal-averaged ECG[SAECG]) and genotyping. Morphologic data were compared to matched control and unmatched ARVC (arrhythmogenic right ventricular cardiomyopathy) cohorts, and potential associations between morphologic parameters and other variables were explored. RESULTS BrS patients (n = 42, male 86%, age 46±12 years) exhibited normal global RV volume and function, comparable to control, in contrast to significantly larger, impaired RVs in ARVC cohort (RVESV p = 0.0001; RVEDV p<0.0001, RVEF p = 0.002). Compared with control, BrS patients exhibited larger RVOT volumes (7.4 ± 0.7 vs 5.8 ± 0.7 mL/m2, p<0.0001) and wall motion abnormalities (RWMA) (31% vs 0%, p = 0.005); compared with ARVC cohort, the RVOT volumes were similar (7.4 ± 0.7 vs, 8.1 ± 1.7, p = 0.52) and there were less RWMA (31% vs 76%, p = 0.01). Overall 67% BrS patients had abnormal RVOT morphology. Patients with abnormal RVOT tended to be older (48 ± 12 y vs 41 ± 12y, p = 0.06). Rare genetic variants were only observed in patients with abnormal RVOT morphology (36% vs 0%, p = 0.02). CONCLUSIONS Patients with BrS frequently exhibit structural abnormalities localised to the RVOT and these changes may be age- and gene-dependent.
Collapse
|
23
|
Yang L, Ma G, Yu T, Gao H, Wang Y, Wu Y. A case report of Brugada-like ST-segment elevation probably due to coronary vasospasm. Medicine (Baltimore) 2018; 97:e9900. [PMID: 29489690 PMCID: PMC5851773 DOI: 10.1097/md.0000000000009900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Vasospastic angina is caused by sudden occlusive vasoconstriction of a segment of an epicardial artery, with transient ST-segment elevation on electrocardiography. Brugada Syndrome is an inherited arrhythmogenic cardiac disorder with a diagnostic electrocardiography characterized by coved-type ST-segment elevation in right precordial leads (V1-V3). Those two diseases usually have no correlation. In this report, we discuss an interesting case of a patient who was diagnosed as vasospastic angina according to his coronary angiography, but his electrocardiography showed a Brugada-like ST-segment elevation. PATIENT CONCERNS Our patient had a 9-month history of temporary but progressive substernal burning sensation with acid bilges of shoulders and arms, as well as profuse sweating at night. DIAGNOSES Although he had no abnormal laboratory test result, no dysfunctional recorded echocardiogram or documented arrhythmia after being admitted to the hospital, his electrocardiography showed a Brugada-like ST-segment elevation. The coronary angiography result confirmed a diagnosis of vasospastic angina. INTERVENTIONS The patient was prescribed diltiazem, aspirin, isosorbide mononitrate and rosuvastatin and was strongly advised to quit cigarettes and alcohol. OUTCOMES Follow-up at half a year turned out well. LESSONS This case links Brugada syndrome to coronary vasospasm. They may share similar mechanisms. Provocation test and gene test needs to be ran to distinguish both. Long-term follow-up is essential for it may bring a warning sign for life threatening ventricular arrhythmias.
Collapse
Affiliation(s)
- Lu Yang
- Department of Cardiology, Beijing Friendship Hospital
| | - Guodong Ma
- Department of Cardiology, Beijing Friendship Hospital
| | - Tianyu Yu
- Department of Cardiology, Beijing Friendship Hospital
| | - Huikuan Gao
- Department of Cardiology, Beijing Friendship Hospital
| | | | - Yongquan Wu
- Department of Cardiology, Beijing Friendship Hospital
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China
| |
Collapse
|
24
|
Mapping of ventricular arrhythmias using a novel noninvasive epicardial and endocardial electrophysiology system. J Electrocardiol 2018; 51:92-98. [DOI: 10.1016/j.jelectrocard.2017.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Indexed: 11/22/2022]
|
25
|
Metzner A, Wissner E, Tsyganov A, Kalinin V, Schlüter M, Lemes C, Mathew S, Maurer T, Heeger CH, Reissmann B, Ouyang F, Revishvili A, Kuck KH. Noninvasive phase mapping of persistent atrial fibrillation in humans: Comparison with invasive catheter mapping. Ann Noninvasive Electrocardiol 2017; 23:e12527. [PMID: 29271538 PMCID: PMC6931819 DOI: 10.1111/anec.12527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/28/2017] [Indexed: 12/01/2022] Open
Abstract
Background A novel noninvasive epicardial and endocardial electrophysiology system (NEEES) to identify electrical rotors and focal activity in patients with atrial fibrillation (AF) was recently introduced. Comparison of NEEES data with results from invasive mapping is lacking. Methods Six male patients (59 ± 11 years) with persistent AF underwent cardiac mapping with the NEEES, which included the creation of isopotential and phase maps. Then patients underwent catheter mapping using a PentaRay NAV catheter and the CARTO 3 system. Signals acquired by the catheter were analyzed by customized software that applied the same phase mapping algorithm as for the NEEES data. Results In all patients, noninvasive phase mapping revealed short‐lived electrical rotors occurring 1.8 ± 0.3 times per second and demonstrating 1–4 (mean 1.2 ± 0.6) rotation cycles. Most of these rotors (72.7%) aggregated in 2–3 anatomical clusters. In two patients, focal excitation from pulmonary veins was observed. Invasive catheter mapping in the dominant rotor aggregation sites and in the three control sites demonstrated the presence of electrical rotors with properties similar to noninvasively detected rotors. Spearman's correlation coefficient between rotor occurrence rate by noninvasive and invasive mapping was 0.97 (p < .0001). Mean rotors' cycle length at dominant aggregation sites, scores of their full rotations, and the proportion of rotors with clockwise rotation were not significantly different between the mapping modalities. Conclusion In patients with persistent AF, phase processing of unipolar electrograms recorded by catheter mapping could reproduce electrical rotors as characterized by NEEES‐based phase mapping.
Collapse
Affiliation(s)
| | | | - Alexey Tsyganov
- Petrovsky National Research Centre of Surgery, Moscow, Russia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Brugada syndrome is associated with scar and endocardial involvement: Insights from high-density mapping with the Rhythmia™ mapping system. Rev Port Cardiol 2017; 36:773.e1-773.e4. [DOI: 10.1016/j.repc.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/19/2017] [Accepted: 08/24/2017] [Indexed: 11/23/2022] Open
|
27
|
Providência R, Carmo P, Moscoso Costa F, Cavaco D, Morgado F, Scanavacca M, Adragão P. Brugada syndrome is associated with scar and endocardial involvement: Insights from high-density mapping with the Rhythmia™ mapping system. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
28
|
Pappone C, Brugada J, Vicedomini G, Ciconte G, Manguso F, Saviano M, Vitale R, Cuko A, Giannelli L, Calovic Z, Conti M, Pozzi P, Natalizia A, Crisà S, Borrelli V, Brugada R, Sarquella-Brugada G, Guazzi M, Frigiola A, Menicanti L, Santinelli V. Electrical Substrate Elimination in 135 Consecutive Patients With Brugada Syndrome. Circ Arrhythm Electrophysiol 2017; 10:e005053. [DOI: 10.1161/circep.117.005053] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/13/2017] [Indexed: 11/16/2022]
Abstract
Background—
There is emerging evidence that localization and elimination of abnormal electric activity in the epicardial right ventricular outflow tract may be beneficial in patients with Brugada syndrome.
Methods and Results—
A total of 135 symptomatic Brugada syndrome patients having implantable cardiac defibrillator were enrolled: 63 (group 1) having documented ventricular tachycardia (VT)/ventricular fibrillation (VF) and Brugada syndrome–related symptoms, and 72 (group 2) having inducible VT/VF without ECG documentation at the time of symptoms. About 27 patients of group 1 experienced multiple implantable cardiac defibrillator shocks for recurrent VT/VF episodes. Three-dimensional maps before and after ajmaline determined the arrhythmogenic electrophysiological substrate (AES) as characterized by prolonged fragmented ventricular potentials. Primary end point was identification and elimination of AES leading to ECG pattern normalization and VT/VF noninducibility. Extensive areas of AES were found in the right ventricle epicardium, which were wider in group 1 (
P
=0.007). AES increased after ajmaline in both groups (
P
<0.001) and was larger in men (
P
=0.008). The increase of type-1 ST-segment elevation correlated with AES expansion (
r
=0.682,
P
<0.001). Radiofrequency ablation eliminated AES leading to ECG normalization and VT/VF noninducibility in all patients. During a median follow-up of 10 months, the ECG remained normal even after ajmaline in all except 2 patients who underwent a repeated effective procedure for recurrent VF.
Conclusions—
In Brugada syndrome, AES is commonly located in the right ventricle epicardium and ajmaline exposes its extent and distribution, which is correlated with the degree of coved ST-elevation. AES elimination by radiofrequency ablation results in ECG normalization and VT/VF noninducibility. Substrate-based ablation is effective in potentially eliminating the arrhythmic consequences of this genetic disease.
Clinical Trial Registration—
URL:
https://clinicaltrials.gov
. Unique identifier: NCT02641431.
Collapse
Affiliation(s)
- Carlo Pappone
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Josep Brugada
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Gabriele Vicedomini
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Giuseppe Ciconte
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Francesco Manguso
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Massimo Saviano
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Raffaele Vitale
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Amarild Cuko
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Luigi Giannelli
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Zarko Calovic
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Manuel Conti
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Paolo Pozzi
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Andrea Natalizia
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Simonetta Crisà
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Valeria Borrelli
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Ramon Brugada
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Georgia Sarquella-Brugada
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Marco Guazzi
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Alessandro Frigiola
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Lorenzo Menicanti
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| | - Vincenzo Santinelli
- From the Arrhythmology Department (C.P., G.V., G.C., F.M., M.S., R.V., A.C., L.G., Z.C., M.C., A.N., S.C., V.B., V.S.) and Cardiac Surgery Department (A.F., L.M.), IRCCS Policlinico San Donato, San Donato Milanese, Italy; Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia (J.B.); Cardiology Department, Hospital Trueta, Girona, Spain (R.B.); Department of Medical Sciences, University of Girona & IDIBGI, Spain ; Pediatric Arrhythmias,
| |
Collapse
|