Document Detail

Site-specific arrhythmogenesis in patients with Brugada syndrome.
MedLine Citation:
PMID:  12741708     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: It has been believed that electrophysiologic abnormality of the epicardial region of the right ventricular free wall may play an important role in arrhythmogenesis of phase 2 reentry in Brugada syndrome, but clinical evidence of the occurrence of ventricular arrhythmias at the right ventricular free wall has not been evaluated. In this study, we evaluated the site-specific inducibility of ventricular fibrillation (VF) and the origin of spontaneous premature ventricular contractions (PVCs) in patients with Brugada syndrome. METHODS AND RESULTS: Forty-five patients with Brugada-type ECG were enrolled in this study. Spontaneous PVCs were recorded in 9 patients. Programmed electrical stimulation (PES) was performed at the right ventricular apex (RVA), the free wall and septal region of the right ventricular outflow tract (RVOT), and the left ventricle (LV). The inducibility of PVT/VF was evaluated at each ventricular site, and the origin of PVC was determined by pace mapping. Sustained VF was induced in 17 patients. VF was induced in all 17 patients by PES at RVOT. Although PES at the septal region of the RVOT induced VF in only 5 patients (29%), PES at the free-wall region of the RVOT induced PVT/VF in 13 patients (76%). PES at RVA induced VF in only 2 patients (12%), and PES at LV failed to induce any arrhythmic events. Ventricular pace mapping showed that 64% of PVCs occurred at the free-wall region of the RVOT, 18% at the septal region of the RVOT, 9% at RVA, and 9% at LV. CONCLUSION: VF in patients with Brugada syndrome frequently is induced at the free-wall region of the RVOT area. The origin of PVC appears to be related to the site of PVT/VF induction by PES.
Hiroshi Morita; Kengo Fukushima-Kusano; Satoshi Nagase; Shiho Takenaka-Morita; Nobuhiro Nishii; Mikio Kakishita; Kazufumi Nakamura; Tetsuro Emori; Hiromi Matsubara; Tohru Ohe
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  14     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-05-13     Completed Date:  2003-08-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  373-9     Citation Subset:  IM    
Department of Cardiovascular Medicine, Okayama University Graduate School, Okayama, Japan.
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MeSH Terms
Arrhythmias, Cardiac / etiology*,  pathology
Death, Sudden, Cardiac / pathology*
Electric Stimulation
Heart Conduction System / physiology
Middle Aged
Refractory Period, Electrophysiological
Ventricular Fibrillation / pathology*
Ventricular Function, Left
Ventricular Function, Right
Ventricular Outflow Obstruction / physiopathology
Comment In:
J Cardiovasc Electrophysiol. 2003 Apr;14(4):380-2   [PMID:  12741709 ]

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