High-density epicardial mapping in Brugada syndrome: Depolarization and repolarization abnormalities

Pannone, Luigi; Monaco, Cinzia; Sorgente, Antonio; Vergara, Pasquale; Călburean, Paul-Adrian; Gauthey, Anaïs; Bisignani, Antonio; Kazawa, Shuichiro; Strazdas, Antanas; Mojica, Joerelle; Lipartiti, Felicia; Housari, Maysam Al; Miraglia, Vincenzo; Rizzi, Sergio; Sofianos, Dimitrios; Cecchini, Federico; Osório, Thiago Guimarães; Paparella, Gaetano; Ramak, Robbert; Overeinder, Ingrid; Bala, Gezim; Almorad, Alexandre; Ströker, Erwin; Pappaert, Gudrun; Sieira, Juan; Brugada, Pedro; Meir, Mark La; Chierchia, Gian Battista; Asmundis, Carlo de

doi:10.1016/j.hrthm.2021.09.032

Cited by 30 publications

(18 citation statements)

References 19 publications

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“… 24 Importantly, AJT helped to unmask the electrical substrate both in terms of area and duration of fragmentation. 25 Noticeably, our group demonstrated that SCD‐BrS patients had longer fragmented potentials during high‐density electroanatomic mapping, only after AJT 26 ; furthermore, we found a significant correlation between RVOT‐AT and abnormal fragmented potentials activation time, both before (ρ=0.76) and after (ρ=0.82) ajmaline infusion. 26 RVOT‐AT might be a noninvasive measure of delayed fragmented epicardial potentials, and this may explain the higher RVOT‐AT observed in SCD‐BrS patients after AJT.…”

Section: Discussionmentioning

confidence: 51%

Ajmaline‐Induced Abnormalities in Brugada Syndrome: Evaluation With ECG Imaging

Pannone

Monaco

Sorgente

et al. 2022

JAHA

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Background The rate of sudden cardiac death (SCD) in Brugada syndrome (BrS) is ≈1%/y. Noninvasive electrocardiographic imaging is a noninvasive mapping system that has a role in assessing BrS depolarization and repolarization abnormalities. This study aimed to analyze electrocardiographic imaging parameters during ajmaline test (AJT). Methods and Results All consecutive epicardial maps of the right ventricle outflow tract (RVOT‐EPI) in BrS with CardioInsight were retrospectively analyzed. (1) RVOT‐EPI activation time (RVOT‐AT); (2) RVOT‐EPI recovery time, and (3) RVOT‐EPI activation‐recovery interval (RVOT‐ARI) were calculated. ∆RVOT‐AT, ∆RVOT‐EPI recovery time, and ∆RVOT‐ARI were defined as the difference in parameters before and after AJT. SCD‐BrS patients were defined as individuals presenting a history of aborted SCD. Thirty‐nine patients with BrS were retrospectively analyzed and 12 patients (30.8%) were SCD‐BrS. After AJT, an increase in both RVOT‐AT [105.9 milliseconds versus 65.8 milliseconds, P <0.001] and RVOT‐EPI recovery time [403.4 milliseconds versus 365.7 milliseconds, P <0.001] was observed. No changes occurred in RVOT‐ARI [297.5 milliseconds versus 299.9 milliseconds, P =0.7]. Before AJT no differences were observed between SCD‐BrS and non SCD‐BrS in RVOT‐AT, RVOT‐EPI recovery time, and RVOT‐ARI ( P =0.9, P =0.91, P =0.86, respectively). Following AJT, SCD‐BrS patients showed higher RVOT‐AT, higher ∆RVOT‐AT, lower RVOT‐ARI, and lower ∆RVOT‐ARI ( P <0.001, P <0.001, P =0.007, P =0.002, respectively). At the univariate logistic regression, predictors of SCD‐BrS were the following: RVOT‐AT after AJT (specificity: 0.74, sensitivity 1.00, area under the curve 0.92); ∆RVOT‐AT (specificity: 0.74, sensitivity 0.92, area under the curve 0.86); RVOT‐ARI after AJT (specificity 0.96, sensitivity 0.58, area under the curve 0.79), and ∆RVOT‐ARI (specificity 0.85, sensitivity 0.67, area under the curve 0.76). Conclusions Noninvasive electrocardiographic imaging can be useful in evaluating the results of AJT in BrS.

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Section: Discussionmentioning

confidence: 51%

Ajmaline‐Induced Abnormalities in Brugada Syndrome: Evaluation With ECG Imaging

Pannone

Monaco

Sorgente

et al. 2022

JAHA

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“…Furthermore, Pannone et al ( 16) also evaluated the ECGI and EAM analyses in BrS patients with a history of aborted SCD, which showed a significantly higher RVOT-AT and lower RVOT activation-recovery interval (RVOT-ARI) in ECGI after ajmaline administration compared to patients without a history of aborted SCD. Consistently, EAM analysis confirmed that BrS patients with a history of aborted SCD had significantly higher HFPat, LFPat, and LFPd, indicating that RVOT conduction delay also plays an important role in the development of VTA in BrS patients (17). It appears that ajmaline, a sodium channel blocker agent, could unmask the covert electrical substrate that caused the RVOT conduction delay in BrS patients.…”

Section: Discussionmentioning

confidence: 56%

“…Pannone et al performed a high-density RVOT epicardial electroanatomic mapping (EAM) analysis using an ajmaline test in BrS patients and showed the presence of highfrequency potentials (HFPs) in all patients before and after the ajmaline test, and low-frequency potentials (LFPs) in all patients after the ajmaline test. HFPs and LFPs, which were the expression of abnormal depolarization and repolarization, respectively, were correlated with RVOT conduction delay (17).…”

Section: Discussionmentioning

confidence: 94%

“…Secondly, a positive aVR sign and large S wave in the lead I were significantly associated with higher MAE risk in BrS patients. Up until now, there are two widely accepted hypotheses related to the pathomechanism of BrS, including repolarization and depolarization abnormalities, which all originated from RVOT (17,34). Pannone et al performed a high-density RVOT epicardial electroanatomic mapping (EAM) analysis using an ajmaline test in BrS patients and showed the presence of highfrequency potentials (HFPs) in all patients before and after the ajmaline test, and low-frequency potentials (LFPs) in all patients after the ajmaline test.…”

Section: Discussionmentioning

confidence: 99%

“…Studies by Coronel et al (15) and Panonne et al (16)(17)(18) also discovered the right ventricular outflow tract (RVOT) conduction delay as the origin of VTA in BrS patients. Therefore, hypothetically, RVOT conduction delay sign may predict the VTA events in BrS patients.…”

Section: Introductionmentioning

confidence: 99%

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Electrocardiographic Markers Indicating Right Ventricular Outflow Tract Conduction Delay as a Predictor of Major Arrhythmic Events in Patients With Brugada Syndrome: A Systematic Review and Meta-Analysis

Iqbal

Putra

Pranata

et al. 2022

Front. Cardiovasc. Med.

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IntroductionRisk stratification in Brugada Syndrome (BrS) patients is still challenging due to the heterogeneity of clinical presentation; thus, some additional risk markers are needed. Several studies investigating the association between RVOT conduction delay sign on electrocardiography (ECG) and major arrhythmic events (MAE) in BrS patients showed inconclusive results. This meta-analysis aims to evaluate the association between RVOT conduction delay signs presented by aVR sign and large S wave in lead I, and MAE in BrS patients.MethodsThe literature search was performed using several online databases from the inception to March 16th, 2022. We included studies consisting of two main components, including ECG markers of RVOT conduction delay (aVR sign and large S wave in lead I) and MAE related to BrS (syncope/VT/VF/SCD/aborted SCD/appropriate ICD shocks)ResultsMeta-analysis of eleven cohort studies with a total of 2,575 participants showed RVOT conduction delay sign was significantly associated with MAE in BrS patients [RR = 1.87 (1.35, 2.58); p < 0.001; I2= 52%, Pheterogeneity = 0.02]. Subgroup analysis showed that aVR sign [RR = 2.00 (1.42, 2.83); p < 0.001; I2= 0%, Pheterogeneity = 0.40] and large S wave in lead I [RR = 1.74 (1.11, 2.71); p = 0.01; I2= 60%, Pheterogeneity = 0.01] were significantly associated with MAE. Summary receiver operating characteristics analysis revealed the aVR sign [AUC: 0.77 (0.73–0.80)] and large S wave in lead I [AUC: 0.69 (0.65–0.73)] were a good predictor of MAE in BrS patients.ConclusionRVOT conduction delay sign, presented by aVR sign and large S wave in the lead I, is significantly associated with an increased risk of MAE in BrS patients. Hence, we propose that these parameters may be useful as an additional risk stratification tool to predict MAE in BrS patients.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/#recordDetails, identifier: CRD42022321090.

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