Correlation between functional and ultrastructural substrate in Brugada syndrome

Tauber, Pablo E.; Mansilla, V.; Mercau, Guillermo; Albano, Felix; Corbalán, R; Sánchez, Sara S.; Honoré, Stella M.

doi:10.1016/j.hrcr.2015.12.001

Cited by 6 publications

(3 citation statements)

References 13 publications

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“…A pharmacologic or a warm water provocation test can be considered to identify potential arrhythmogenic substrates (Table 3 , Ref. [ 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 ]).…”

Section: Outcomes Of Rfca In Different Entities Of Acmmentioning

confidence: 99%

Catheter Ablation in Arrhythmic Cardiac Diseases: Endocardial and Epicardial Ablation

Cheng¹,

Chung²,

Lin³

et al. 2022

Rev. Cardiovasc. Med.

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Arrhythmogenic cardiomyopathy (ACM) is a group of arrhythmogenic disorders of the myocardium that are not caused by ischemic, hypertensive, or valvular heart disease. The clinical manifestations of ACMs may overlap those of dilated cardiomyopathy, complicating the differential diagnosis. In several ACMs, ventricular tachycardia (VT) has been observed at an early stage, regardless of the severity of the disease. Therefore, preventing recurrences of VT can be a clinical challenge. There is a wide range of efficacy and side effects associated with the use of antiarrhythmic drugs (AADs) in the treatment of VT. In addition to AADs, patients with ACM and ventricular tachyarrhythmias may benefit from catheter ablation, especially if they are drug-refractory. The differences in pathogenesis between the various types of ACMs can lead to heterogeneous distributions of arrhythmogenic substrates, non-uniform ablation strategies, and distinct ablation outcomes. Ablation has been documented to be effective in eliminating ventricular tachyarrhythmias in arrhythmogenic right ventricular dysplasia (ARVC), sarcoidosis, Chagas cardiomyopathy, and Brugada syndrome (BrS). As an entity that is rare in nature, ablation for ventricular tachycardia in certain forms of ACM may only be reported through case reports, such as amyloidosis and left ventricular noncompaction. Several types of ACMs, including ARVC, sarcoidosis, Chagas cardiomyopathy, BrS, and left ventricular noncompaction, may exhibit diseased substrates within or adjacent to the epicardium that may be accountable for ventricular arrhythmogenesis. As a result, combining endocardial and epicardial ablation is of clinical importance for successful ablation. The purpose of this article is to provide a comprehensive overview of the substrate characteristics, ablation strategies, and ablation outcomes of various types of ACMs using endocardial and epicardial approaches.

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Section: Outcomes Of Rfca In Different Entities Of Acmmentioning

confidence: 99%

Catheter Ablation in Arrhythmic Cardiac Diseases: Endocardial and Epicardial Ablation

Cheng¹,

Chung²,

Lin³

et al. 2022

Rev. Cardiovasc. Med.

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“…Tauber et al. reported interesting data about EMB performed, epicardially, from three different areas according to EGM severity at three degrees of voltage reduction (< 0.5 mV, 0.5 to 1.5 mV and normal, > 1.5 mV), uncovering ultrastructural abnormalities concordant with voltage lowering but not with the normal voltage areas 61 …”

Section: Clinical Settingsmentioning

confidence: 99%

Electroanatomic voltage mapping for tissue characterization beyond arrhythmia definition: A systematic review

Zoppo

Gagno

Perazza

et al. 2021

Pacing Clinical Electrophis

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Three‐dimensional (3D) reconstruction by means of electroanatomic mapping (EAM) systems, allows for the understanding of the mechanism of focal or re‐entrant arrhythmic circuits, which can be identified by means of dynamic (activation and propagation) and static (voltage) color‐coded maps. However, besides this conventional use, EAM may offer helpful anatomical and functional information for tissue characterisation in several clinical settings. Today, data regarding electromechanical myocardial viability, scar detection in ischaemic and nonischaemic cardiomyopathy and arrhythmogenic right ventricle dysplasia (ARVC/D) definition are mostly consolidated, while emerging results are becoming available in contexts such as Brugada syndrome and cardiac resynchronisation therapy (CRT) implant procedures. As part of an invasive procedure, EAM has not yet been widely adopted as a stand‐alone tool in the diagnostic path. We aim to review the data in the current literature regarding the use of 3D EAM systems beyond the definition of arrhythmia.

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“…Known BrS-susceptibility genes can only partially explain the clinically diagnosed cases; therefore, many patients (65-70%) remain "genetically unresolved" [8,9]. For many years, BrS has been considered a purely electric disease even if, more recently some authors have shown the presence of morphological and functional abnormalities (regional conduction slow in the endocardium and epicardium), predominantly located in the right ventricle outflow tract (RVOT) [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Endocardial Approach for Substrate Ablation in Brugada Syndrome

Tauber¹,

Mansilla²,

Brugada³

et al. 2018

Cardiac Arrhythmias

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Radiofrequency ablation (RFA) in Brugada syndrome (BrS) has been performed by both endocardial and epicardial. The substrate in BrS is not completely understood. We investigate the functional endocardial substrate and its correlation with clinical, electrophysiological and ECG findings in order to guide an endocardial ablation. Two patients agreed to undergo an endocardial biopsy and the samples were examined with transmission electron microscopy (TEM) to investigate the correlation between functional and ultrastructural alterations. About 13 patients (38.7 ± 12.3 years old) with spontaneous type 1 ECG BrS pattern, inducible VF with programmed ventricular stimulation (PVS) and syncope without prodromes were enrolled. Before endocardial mapping, the patients underwent flecainide testing with the purpose of measuring the greatest ST-segment elevation for to be correlated with the size and location of substrate in the electro-anatomic map. Patients underwent endocardial bipolar and electro-anatomic mapping with the purpose of identify areas of abnormal electrograms (EGMs) as target for RFA and determine the location and size of the substrate. When the greatest ST-segment elevation was in the third intercostal space (ICS), the substrate was located upper in the longitudinal plane of the right ventricular outflow tract (RVOT) and a greatest ST-segment elevation in fourth ICS correspond with a location of substrate in lower region of longitudinal plane of RVOT. A QRS complex widening on its initial and final part, with prolonged transmural and regional depolarization time of RVOT corresponded to the substrate located in the anterior-lateral region of RVOT. A QRS complex widening rightwards and only prolonged transmural depolarization time corresponded with a substrate located in the anterior, anterior-septal or septal region of RVOT. RFA of endocardial substrate suppressed the inducibility and ECG BrS pattern during 34.7 ± 15.5 months. After RFA, flecainide testing confirmed elimination of the ECG BrS

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Correlation between functional and ultrastructural substrate in Brugada syndrome

Cited by 6 publications

References 13 publications

Catheter Ablation in Arrhythmic Cardiac Diseases: Endocardial and Epicardial Ablation

Catheter Ablation in Arrhythmic Cardiac Diseases: Endocardial and Epicardial Ablation

Electroanatomic voltage mapping for tissue characterization beyond arrhythmia definition: A systematic review

Endocardial Approach for Substrate Ablation in Brugada Syndrome

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