Brugada综合征患者心室颤动的体内标测：复极异质性的作用
In Vivo Mapping of Human Ventricular Fibrillation in Brugada Syndrome: The Role of Repolarization Heterogeneity.
作者信息
Pannone Luigi, Della Rocca Domenico Giovanni, Vergara Pasquale, Sorgente Antonio, Del Monte Alvise, Vetta Giampaolo, Cespon Fernandez Maria, Talevi Giacomo, Eltsov Ivan, Calburean Paul-Adrian, Overeinder Ingrid, Bala Gezim, Almorad Alexandre, Ströker Erwin, Pappaert Gudrun, Sieira Juan, de Ravel Thomy, Van Dooren Sonia, Gharaviri Ali, La Meir Mark, Brugada Pedro, Chierchia Gian Battista, Sarkozy Andrea, de Asmundis Carlo
机构信息
Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart (L.P., D.G.D.R., P.V., A. Sorgente, A.D.M., G.V., M.C.F., G.T., I.E., P.-A.C., I.O., G.B., A.A., E.S., G.P., J.S., A.G., P.B., G.B.C., A. Sarkozy, C.d.A.), Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Belgium.
Centre for Medical Genetics (T.d.R., S.V.D.), Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Clinical Sciences, Research Group Reproduction and Genetics, Belgium.
出版信息
Circ Arrhythm Electrophysiol. 2024 Dec;17(12):e013290. doi: 10.1161/CIRCEP.124.013290. Epub 2024 Dec 3.
BACKGROUND
Brugada syndrome (BrS) is associated with ventricular fibrillation (VF). Different VF mechanisms have been described, and repolarization gradients were associated with VF in a BrS model. The aim of this study is to map VF in BrS with ECG imaging. Furthermore, spatial correlation between sinus rhythm maps and VF maps was evaluated.
METHODS
Inclusion criteria were (1) BrS diagnosis and (2) VF mapped with ECG imaging during right ventricle outflow tract ablation. VF mechanism was classified into (1) rotational, (2) focal, and (3) irregular. For comparison, 6 controls were enrolled. The following sinus rhythm maps were performed: activation, recovery time, and activation-recovery interval time. Spatial overlap between steep repolarization gradients (cliffs) at recovery time and activation-recovery interval time maps and initiating VF rotational activity was evaluated with photogrammetry.
RESULTS
A total of 28 VF maps in 21 patients with BrS were analyzed. In the first ≈7 seconds of VF, rotational, focal, and irregular mechanisms were found. In 19 patients with BrS (90.5%) and none of the controls, a right ventricle outflow tract repolarization cliff only was found. In all these patients, the singularity point of the first initiating rotational VF activity spatially overlapped with the right ventricle outflow tract cliff. Abolition of right ventricle outflow tract repolarization cliffs was confirmed in all but 2 patients (94.3%). In one patient with recurrence, VF was mapped on the anterior right ventricle over a cliff that was not targeted at the first ablation procedure.
CONCLUSIONS
In patients with BrS, repolarization heterogeneity has a critical role in VF. Repolarization cliffs might be a therapeutic target in VF ablation.
背景
Brugada综合征（BrS）与室颤（VF）相关。已描述了不同的室颤机制，并且在BrS模型中复极梯度与室颤有关。本研究的目的是通过心电图成像绘制BrS患者的室颤图。此外，还评估了窦性心律图与室颤图之间的空间相关性。
方法
纳入标准为：（1）BrS诊断；（2）在右心室流出道消融期间通过心电图成像绘制室颤图。室颤机制分为：（1）旋转性；（2）局灶性；（3）不规则性。为作比较，纳入了6名对照者。进行了以下窦性心律图绘制：激动、恢复时间以及激动-恢复间期时间。通过摄影测量法评估恢复时间图和激动-恢复间期时间图上陡峭复极梯度（悬崖）与起始室颤旋转活动之间的空间重叠。
结果
共分析了21例BrS患者的28份室颤图。在室颤的最初约7秒内，发现了旋转性、局灶性和不规则性机制。在19例BrS患者（90.5%）中仅发现右心室流出道复极悬崖，而对照者中均未发现。在所有这些患者中，首次起始旋转性室颤活动的奇点在空间上与右心室流出道悬崖重叠。除2例患者（94.3%）外，所有患者的右心室流出道复极悬崖均被证实消除。在1例复发患者中，室颤在右心室前壁的一个悬崖上被绘制出来，该悬崖在首次消融手术时未被作为靶点。
结论
在BrS患者中，复极异质性在室颤中起关键作用。复极悬崖可能是室颤消融的治疗靶点。
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