TY - JOUR
T1 - Right ventricular outflow tract electroanatomical abnormalities in asymptomatic and high-risk symptomatic patients with Brugada syndrome
T2 - Evidence for a new risk stratification tool?
AU - Letsas, Konstantinos P.
AU - Vlachos, Konstantinos
AU - Conte, Giulio
AU - Efremidis, Michael
AU - Nakashima, Takashi
AU - Duchateau, Josselin
AU - Bazoukis, George
AU - Frontera, Antonio
AU - Mililis, Panagiotis
AU - Tse, Gary
AU - Cheniti, Ghassen
AU - Takigawa, Masateru
AU - Pambrun, Thomas
AU - Prappa, Efstathia
AU - Sacher, Frederic
AU - Derval, Nicolas
AU - Sideris, Antonios
AU - Auricchio, Angelo
AU - Jais, Pierre
AU - Haissaguerre, Michel
AU - Hocini, Meleze
N1 - Publisher Copyright:
© 2021 Wiley Periodicals LLC
PY - 2021/11
Y1 - 2021/11
N2 - Introduction: Microstructural abnormalities at the epicardium of the right ventricular outflow tract (RVOT) may provide the arrhythmia substrate in Brugada syndrome (BrS). Endocardial unipolar electroanatomical mapping allows the identification of epicardial abnormalities. We evaluated the clinical implications of an abnormal endocardial substrate as perceived by high-density electroanatomical mapping (HDEAM) in patients with BrS. Methods: Fourteen high-risk BrS patients with aborted sudden cardiac death (SCD) (12 males, mean age: 41.9 ± 11.8 years) underwent combined endocardial-epicardial HDEAM of the right ventricle/RVOT, while 40 asymptomatic patients (33 males, mean age: 42 ± 10.7 years) underwent endocardial HDEAM. Based on combined endocardial-epicardial procedures, endocardial HDEAM was considered abnormal in the presence of low voltage areas (LVAs) more than 1 cm2 with bipolar signals less than 1 mV and unipolar signals less than 5.3 mV. Programmed ventricular stimulation (PVS) was performed in all patients. Results: The endocardial unipolar LVAs were colocalized with epicardial bipolar LVAs (p =.0027). Patients with aborted SCD exhibited significantly wider endocardial unipolar (p <.01) and bipolar LVAs (p <.01) compared with asymptomatic individuals. A substrate size of unipolar LVAs more than 14.5 cm2 (area under the curve [AUC]: 0.92, p <.001] and bipolar LVAs more than 3.68 cm2 (AUC: 0.82, p =.001) distinguished symptomatic from asymptomatic patients. Patients with ventricular fibrillation inducibility (23/54) demonstrated broader endocardial unipolar (p <.001) and bipolar LVAs (p <.001) than noninducible patients. The presence of unipolar LVAs more than 13.5 cm2 (AUC: 0.95, p <.001) and bipolar LVAs more than 2.97 cm2 (AUC: 0.78, p <.001) predicted a positive PVS. Conclusion: Extensive endocardial electroanatomical abnormalities identify high-risk patients with BrS. Endocardial HDEAM may allow risk stratification of asymptomatic patients referred for PVS.
AB - Introduction: Microstructural abnormalities at the epicardium of the right ventricular outflow tract (RVOT) may provide the arrhythmia substrate in Brugada syndrome (BrS). Endocardial unipolar electroanatomical mapping allows the identification of epicardial abnormalities. We evaluated the clinical implications of an abnormal endocardial substrate as perceived by high-density electroanatomical mapping (HDEAM) in patients with BrS. Methods: Fourteen high-risk BrS patients with aborted sudden cardiac death (SCD) (12 males, mean age: 41.9 ± 11.8 years) underwent combined endocardial-epicardial HDEAM of the right ventricle/RVOT, while 40 asymptomatic patients (33 males, mean age: 42 ± 10.7 years) underwent endocardial HDEAM. Based on combined endocardial-epicardial procedures, endocardial HDEAM was considered abnormal in the presence of low voltage areas (LVAs) more than 1 cm2 with bipolar signals less than 1 mV and unipolar signals less than 5.3 mV. Programmed ventricular stimulation (PVS) was performed in all patients. Results: The endocardial unipolar LVAs were colocalized with epicardial bipolar LVAs (p =.0027). Patients with aborted SCD exhibited significantly wider endocardial unipolar (p <.01) and bipolar LVAs (p <.01) compared with asymptomatic individuals. A substrate size of unipolar LVAs more than 14.5 cm2 (area under the curve [AUC]: 0.92, p <.001] and bipolar LVAs more than 3.68 cm2 (AUC: 0.82, p =.001) distinguished symptomatic from asymptomatic patients. Patients with ventricular fibrillation inducibility (23/54) demonstrated broader endocardial unipolar (p <.001) and bipolar LVAs (p <.001) than noninducible patients. The presence of unipolar LVAs more than 13.5 cm2 (AUC: 0.95, p <.001) and bipolar LVAs more than 2.97 cm2 (AUC: 0.78, p <.001) predicted a positive PVS. Conclusion: Extensive endocardial electroanatomical abnormalities identify high-risk patients with BrS. Endocardial HDEAM may allow risk stratification of asymptomatic patients referred for PVS.
KW - Brugada syndrome
KW - ablation
KW - mapping
KW - risk stratification
UR - http://www.scopus.com/inward/record.url?scp=85116415397&partnerID=8YFLogxK
U2 - 10.1111/jce.15262
DO - 10.1111/jce.15262
M3 - Article
C2 - 34596938
AN - SCOPUS:85116415397
SN - 1045-3873
VL - 32
SP - 2997
EP - 3007
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
IS - 11
ER -