Circulation. Arrhythmia and electrophysiology · 2024
In Vivo Mapping of Human Ventricular Fibrillation in Brugada Syndrome: The Role of Repolarization Heterogeneity.
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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
Аннотация
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.
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.