Activation Pattern of the Polymorphic Ventricular Tachycardia and Ventricular Fibrillation on Body Surface Mapping in Patients With Brugada Syndrome

Background:Clinical and experimental studies have shown the existence of an arrhythmogenic substrate in the right ventricular outflow tract (RVOT) in patients with Brugada syndrome (BrS). To evaluate the importance of the RVOT, we evaluated the activation pattern of induced ventricular tachyarrhythm...

Full description

Saved in:
Bibliographic Details
Published in:Circulation Journal 2016/07/25, Vol.80(8), pp.1734-1743
Main Authors: Ueoka, Akira, Morita, Hiroshi, Watanabe, Atsuyuki, Nakagawa, Koji, Nishii, Nobuhiro, Nagase, Satoshi, Ohe, Tohru, Ito, Hiroshi
Format: Article
Language:English
Subjects:
Adult
Body surface mapping
Body Surface Potential Mapping
Brugada syndrome
Brugada Syndrome - complications
Brugada Syndrome - physiopathology
Electrocardiography
Female
Humans
Male
Middle Aged
Tachycardia, Ventricular - complications
Tachycardia, Ventricular - physiopathology
Ventricular fibrillation
Ventricular Fibrillation - complications
Ventricular Fibrillation - physiopathology
Ventricular tachycardia
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background:Clinical and experimental studies have shown the existence of an arrhythmogenic substrate in the right ventricular outflow tract (RVOT) in patients with Brugada syndrome (BrS). To evaluate the importance of the RVOT, we evaluated the activation pattern of induced ventricular tachyarrhythmias using body surface mapping (BSM) in patients with BrS.Methods and Results:We examined 14 patients with BrS in whom ventricular tachyarrhythmias were induced by programmed electrical stimulation. The 87-lead BSM was recorded during induced ventricular tachyarrhythmias, and an activation map and an isopotential map of QRS complexes every 5 ms were constructed to evaluate the activation pattern of ventricular tachyarrhythmias. BSM during 20 episodes of ventricular tachyarrhythmias induced at the RVOT showed that repetitive excitation was generated at the RVOT and propagated to the inferior RV and left ventricle, and then returned to the RVOT. Polymorphic QRS change during ventricular tachyarrhythmias was associated with migration of the earliest activation site and rotor. BSM during 4 episodes of ventricular fibrillation (VF) showed that the excitation front moved randomly with formation of multiple wavefronts.Conclusions:Programmed stimulation initiated repetitive firing from the RVOT. Migration and competition of the earliest activation site and rotor and local conduction delay changed the QRS morphology. Degeneration of the reentrant circuit into multiple wavefronts resulted in VF. (Circ J 2016; 80: 1734–1743)
ISSN:1346-9843
1347-4820
DOI:10.1253/circj.CJ-16-0124