A novel method to enhance phenotype, epicardial functional substrates, and ventricular tachyarrhythmias in Brugada syndrome

被引：40

作者：

Chung, Fa-Po ^{[1
,2
,3
]}

Raharjo, Sunu Budhi ^{[2
]}

Lin, Yenn-Jiang ^{[2
,3
]}

Chang, Shih-Lin ^{[2
,3
]}

Lo, Li-Wei ^{[2
,3
]}

Hu, Yu-Feng ^{[2
,3
]}

Tuan, Ta-Chuan ^{[2
,3
]}

Chao, Tze-Fan ^{[2
,3
]}

Liao, Jo-Nan ^{[2
,3
]}

Lin, Chin-Yu ^{[2
,3
]}

Chang, Yao-Ting ^{[2
,3
]}

Hung, Yuan ^{[2
]}

Te, Abigail ^{[2
]}

Yamada, Shinya ^{[2
]}

Tasaka, Hiroshi ^{[2
]}

Wang, Chin-Tien ^{[1
]}

Chen, Shih-Ann ^{[2
,3
]}

机构：

[1] Natl Yang Ming Univ, Inst Clin Med, 201,Sec 2,Shih Pai Rd, Taipei, Taiwan

[2] Taipei Vet Gen Hosp, Dept Med, Div Cardiol, Taipei, Taiwan

[3] Natl Yang Ming Univ, Dept Med, Taipei, Taiwan

来源：

HEART RHYTHM | 2017年 / 14卷 / 04期

关键词：

Brugada syndrome; Catheter ablation; Epicardial warm water instillation; Functional substrates; Ventricular tachyarrhythmias; CATHETER ABLATION; FIBRILLATION; MECHANISMS; MUTATIONS; FEVER;

D O I：

10.1016/j.hrthm.2017.01.006

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Fever is associated with the manifestation of Brugada phenotype and ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with Brugada syndrome (BrS). The thermal effect on the pathogenesis of functional substrates in BrS remains unknown. OBJECTIVE This study aimed to elucidate the thermal effect on BrS phenotype, VT/VF, and electrophysiological characteristics of epicardial functional substrates in BrS. METHODS We consecutively studied 15 patients with BrS receiving radiofrequency catheter ablation for drug-refractory ventricular tachyarrhythmias. Baseline characteristics, electrocardiographic features, and changes in epicardial functional substrates before and after epicardial warm water instillation (n = 6) were recorded and analyzed. RESULTS A total of 15 male patients (mean age 41.3 +/- 10.3 years) with type 1 BrS presenting with ventricular tachyarrhythmias were consecutively enrolled. Epicardial mapping in 11 patients demonstrated a significantly larger epicardial scar/low-voltage zone (LVZ) area within the right ventricular outflow tract and anterior right ventricular free wall than within the endocardium (6.32 +/- 12.74 cm(2) vs 52.91 +/- 45.25 cm(2); P = .007). Epicardial warm water instillation in 6 patients led to a significant enlargement of the functional scar/LVZ area (123.83 +/- 35.26 cm(2) vs 63.53 +/- 40.57 cm(2); P = .03), accelerated conduction velocity of the endocardium and epicardium without scar/LVZ area, and increased VT/VF inducibility (16.7% vs 100%; P = .02). Ablation by targeting premature ventricular complexes and/or epicardial abnormal substrates rendered noninducibility of VT/VF and prevented the recurrences of VT/V F. CONCLUSION Epicardial warm water instillation enhanced functional epicardial substrates, which contributed to the increased inducibility of ventricular tachyarrhythmias in BrS. Ablation by targeting the triggers and abnormal epicardial substrates provided an effective strategy for preventing ventricular tachyarrhythmia recurrences in BrS.

引用

页码：508 / 517

页数：10

共 15 条

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