Right ventricular dysfunction in patients with Brugada-like electrocardiography: a two dimensional strain imaging study

Background: Sodium channel blockers augment ST-segment elevation in the right precordial leads in patients undergoing Brugada-type electrocardiography (ECG). However, their effect on echocardiographic features is not known. We address this by assessing global and regional ventricular function using conventional Doppler and two-dimensional (2D) speckle tracking techniques. Methods: Thirty-one patients with Brugada-type ECG were studied. A pure sodium channel blocker, pilsicainide, was used to provoke an ECG response. The percentage longitudinal systolic myocardial strain at the base of both the right ventricular (RV) free wall and the interventricular septum wall was measured using 2D speckle tracking. Left ventricular (LV) and RV myocardial performance (TEI) indices were also measured. Results: The pilsicainide challenge provoked a positive ECG response in 13 patients (inducible group). In the inducible group, longitudinal strain was significantly reduced only at the RV (-27.3 +/- 5.4% vs -22.1 +/- 3.6%, P < 0.01), and both RV and LV TEI indices increased (RV: 0.19 +/- 0.09 vs 0.27 +/- 0.11, P < 0.05; LV: 0.30 +/- 0.10 vs 0.45 +/- 0.10, P < 0.01) after pilsicainide administration. Conclusions: Temporal and spatial analysis using the TEI index and 2D strain imaging revealed the deterioration of global ventricular function associated with conduction disturbance and RV regional function in patients with Brugada-type ECG and coved type ST elevation due to administration of a sodium channel blocker.