Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy.
Institute of Clinical Physiology, Pisa, Italy.
J Cardiovasc Electrophysiol. 2024 May;35(5):965-974. doi: 10.1111/jce.16244. Epub 2024 Mar 13.
Repolarization dispersion in the right ventricular outflow tract (RVOT) contributes to the type-1 electrocardiographic (ECG) phenotype of Brugada syndrome (BrS), while data on the significance and feasibility of mapping repolarization dispersion in BrS patients are scarce. Moreover, the role of endocardial repolarization dispersion in BrS is poorly investigated. We aimed to assess endocardial repolarization patterns through an automated calculation of activation recovery interval (ARI) estimated on unipolar electrograms (UEGs) in spontaneous type-1 BrS patients and controls; we also investigated the relation between ARI and right ventricle activation time (RVAT), and T-wave peak-to-end interval (Tpe) in BrS patients.
Patients underwent endocardial high-density electroanatomical mapping (HDEAM); BrS showing an overt type-1 ECG were defined as OType1, while those without (latent type-1 ECG and LType1) received ajmaline infusion. BrS patients only underwent programmed ventricular stimulation (PVS). Data were elaborated to obtain ARI corrected with the Bazett formula (ARIc), while RVAT was derived from activation maps.
39 BrS subjects (24 OType1 and 15 LTtype1) and 4 controls were enrolled. OType1 and post-ajmaline LType1 showed longer mean ARIc than controls (306 ± 27.3 ms and 333.3 ± 16.3 ms vs. 281.7 ± 10.3 ms, p = .05 and p < .001, respectively). Ajmaline induced a significant prolongation of ARIc compared to pre-ajmaline LTtype1 (333.3 ± 16.3 vs. 303.4 ± 20.7 ms, p < .001) and OType1 (306 ± 27.3 ms, p < .001). In patients with type-1 ECG (OTtype1 and post-ajmaline LType1) ARIc correlated with RVAT (r = .34, p = .04) and Tpec (r = .60, p < .001), especially in OType1 subjects (r = .55, p = .008 and r = .65 p < .001, respectively).
ARIc mapping demonstrates increased endocardial repolarization dispersion in RVOT in BrS. Endocardial ARIc positively correlates with RVAT and Tpec, especially in OType1.
右心室流出道（RVOT）的复极离散有助于 Brugada 综合征（BrS）的 1 型心电图（ECG）表型，而关于 BrS 患者复极离散的意义和可行性的数据却很少。此外，BrS 中心内膜复极离散的作用仍未得到充分研究。我们旨在通过自动计算在自发 1 型 BrS 患者和对照组的单极电图（UEG）上估计的激活后恢复间期（ARI），评估心内膜复极模式；我们还研究了 ARI 与 BrS 患者右心室激活时间（RVAT）和 T 波峰至末端间期（Tpe）之间的关系。
患者接受心内膜高密度电解剖标测（HDEAM）；表现出明显 1 型 ECG 的 BrS 被定义为 OType1，而无（潜伏型 1 型 ECG 和 LType1）的 BrS 则接受阿马林输注。BrS 患者仅接受程控心室刺激（PVS）。数据经过处理，得到用 Bazett 公式校正的 ARI（ARIc），而 RVAT 则从激活图中得出。
39 名 BrS 患者（24 名 OType1 和 15 名 LTtype1）和 4 名对照者入组。OType1 和阿马林后 LType1 的平均 ARIc 比对照组长（306±27.3ms 和 333.3±16.3ms 比 281.7±10.3ms，p=0.05 和 p<0.001）。阿马林诱导的 ARIc 与阿马林前 LType1（333.3±16.3 比 303.4±20.7ms，p<0.001）和 OType1（306±27.3ms，p<0.001）相比显著延长。在 1 型 ECG（OType1 和阿马林后 LType1）患者中，ARIc 与 RVAT（r=0.34，p=0.04）和 Tpec（r=0.60，p<0.001）相关，特别是在 OType1 患者中（r=0.55，p=0.008 和 r=0.65 p<0.001）。
ARIc 标测显示 BrS 中 RVOT 心内膜复极离散增加。心内膜 ARIc 与 RVAT 和 Tpec 呈正相关，特别是在 OType1 中。
