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

• Ueoka Akira

  Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine and Dentistry

• Morita Hiroshi

  Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine and Dentistry

• Watanabe Atsuyuki

  Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine and Dentistry

• Nakagawa Koji

  Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine and Dentistry

• Nishii Nobuhiro

  Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine and Dentistry

• Nagase Satoshi

  Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine and Dentistry Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

• Ohe Tohru

  Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine and Dentistry Department of Cardiovascular Medicine, Cardiovascular Center Sakakibara Hospital

• Ito Hiroshi

  Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine and Dentistry

Abstract

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)

Journal

• Circulation Journal

  Circulation Journal 80 (8), 1734-1743, 2016

  The Japanese Circulation Society

Keywords

• Body surface mapping
• Brugada syndrome
• Electrocardiography
• Ventricular fibrillation
• Ventricular tachycardia

Details

• CRID: 1390282680082927104
• NII Article ID: 130005166108
• NII Book ID: AA11591968
• DOI: 10.1253/circj.cj-16-0124
• ISSN: 13474820
• ISSN: 13469843
• NDL BIB ID: 027499158
• PubMed: 27319581
• Web Site: https://ndlsearch.ndl.go.jp/books/R000000004-I027499158
• Web Site: https://www.jstage.jst.go.jp/article/circj/80/8/80_CJ-16-0124/_pdf
• Text Lang: en
• Data Source:
  • JaLC
  • NDL
  • Crossref
  • PubMed
  • CiNii Articles
  • KAKEN
• Abstract License Flag: Disallowed