Significant Delayed Activation on the Right Ventricular Outflow Tract Represents Complete Right Bundle-Branch Block Pattern in Brugada Syndrome

被引：2

作者：

Morimoto, Yoshimasa ^{[2
,4
]}

Morita, Hiroshi ^{[1
,3
]}

Ejiri, Kentaro ^{[2
,5
]}

Mizuno, Tomofumi ^{[2
]}

Masuda, Takuro ^{[2
]}

Ueoka, Akira ^{[2
]}

Asada, Saori ^{[2
]}

Miyamoto, Masakazu ^{[2
]}

Kawada, Satoshi ^{[2
]}

Nakagawa, Koji ^{[2
]}

Nishii, Nobuhiro ^{[3
]}

Nakamura, Kazufumi ^{[2
]}

Ito, Hiroshi ^{[2
]}

机构：

[1] Okayama Univ, Dept Cardiovasc Therapeut, Grad Sch Med Dent & Pharmaceut Sci, 2-5-1 Shikata Cho,Kita Ku, Okayama 7008558, Japan

[2] Okayama Univ, Grad Sch Med Dent & Pharmaceut Sci, Dept Cardiovasc Med, Okayama, Japan

[3] Okayama Univ, Grad Sch Med Dent & Pharmaceut Sci, Dept Cardiovasc Therapeut, Okayama, Japan

[4] Fukuyama City Hosp, Dept Cardiovasc Med, Hiroshima, Japan

[5] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA

来源：

JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2023年 / 12卷 / 10期

基金：

日本学术振兴会;

关键词：

activation pattern; body surface map; Brugada syndrome; complete right bundle-branch block; CONDUCTION DISTURBANCES; FIBRILLATION; ABLATION; RISK; ABNORMALITIES; ARRHYTHMIAS; ELECTROGRAM; TACHYCARDIA; EXCITATION; EPISODES;

D O I：

10.1161/JAHA.122.028706

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundThe appearance of complete right bundle-branch block (CRBBB) in Brugada syndrome (BrS) is associated with an increased risk of ventricular fibrillation. The pathophysiological mechanism of CRBBB in patients with BrS has not been well established. We aimed to clarify the significance of a conduction delay zone associated with arrhythmias on CRBBB using body surface mapping in patients with BrS. Methods and ResultsBody surface mapping was recorded in 11 patients with BrS and 8 control patients both with CRBBB. CRBBB in control patients was transiently exhibited by unintentional catheter manipulation (proximal RBBB). Ventricular activation time maps were constructed for both of the groups. We divided the anterior chest into 4 areas (inferolateral right ventricle [RV], RV outflow tract [RVOT], intraventricular septum, and left ventricle) and compared activation patterns between the 2 groups. Excitation propagated to the RV from the left ventricle through the intraventricular septum with activation delay in the entire RV in the control group (proximal RBBB pattern). In 7 patients with BrS, excitation propagated from the inferolateral RV to the RVOT with significant regional activation delay. The remaining 4 patients with BrS showed a proximal RBBB pattern with the RVOT activation delay. The ventricular activation time in the inferolateral RV was significantly shorter in patients with BrS without a proximal RBBB pattern than in control patients. ConclusionsThe CRBBB morphology in patients with BrS consisted of 2 mechanisms: (1) significantly delayed conduction in the RVOT and (2) proximal RBBB with RVOT conduction delay. Significant RVOT conduction delay without proximal RBBB resulted in CRBBB morphology in patients with BrS.

引用

页数：20

共 37 条

[1]

Alexandr JA., 1980, CIRCULATION, V62, P327

[2] Brugada syndrome: 1992-2002 - A historical perspective [J].