CLINICAL STUDY
Epicardial electrogram of the right ventricular outflow tract in patients with the brugada syndrome
Using the epicardial lead
Satoshi Nagase, MD*,*,
Kengo Fukushima Kusano, MD, PhD*,
Hiroshi Morita, MD, PhD*,
Yoshihisa Fujimoto, MD, PhD*,
Mikio Kakishita, MD, PhD*,
Kazufumi Nakamura, MD, PhD*,
Tetsuro Emori, MD*,
Hiromi Matsubara, MD, PhD* and
Tohru Ohe, MD, PhD, FACC*
* Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
Manuscript received September 11, 2001;
revised manuscript received February 14, 2002,
accepted March 27, 2002.
* Reprint requests and correspondence: Dr. Satoshi Nagase, Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
snagase{at}cc.okayama-u.ac.jp
Part of this manuscript was presented at the 22nd Annual Scientific Sessions of the North American Society of Pacing and Electrophysiology, May 2 to 5, 2001, Boston, Massachusetts, and published in abstract form (Pacing Clin Electrophysiol 2001;24 Suppl II:II677).
OBJECTIVES: We tried to record an epicardial electrogram directly, and we examined local electrograms before and after administration of a class IC anti-arrhythmic drug in patients with the Brugada syndrome.
BACKGROUND: Electrical heterogeneity of the epicardium in the right ventricular outflow tract (RVOT) has been thought to be related to the Brugada syndrome. However, an epicardial abnormality has not been demonstrated in patients with the Brugada syndrome.
METHODS: In five patients with a Brugada-type electrocardiogram (ECG), local unipolar electrograms were recorded at the epicardium and endocardium of the RVOT. To record the epicardial electrogram directly, we introduced an electrical guidewire into the conus branch (CB) of the right coronary artery. The duration of the local electrogram after termination of the QRS complex (DP) was measured before and after class IC anti-arrhythmic drug administration. The signal-averaged electrocardiogram (SAECG) was also obtained in all patients.
RESULTS: A definite DP was observed at the epicardium, but not at the endocardium. After administration of a class IC anti-arrhythmic drug, the DP at the epicardium was prolonged from 38 ± 10 ms to 67 ± 24 ms. The late potential corresponding to the DP at the epicardium was observed in all patients on the SAECG.
CONCLUSIONS: An epicardial electrogram can be recorded from the CB. Recording from the CB enables identification of an epicardial abnormality in patients with the Brugada syndrome. These abnormal electrograms may be related to a myocardial abnormality in the epicardium of patients with the Brugada syndrome.
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Abbreviations and Acronyms
| | CB = conus branch | | DP = local electrogram after termination of the QRS complex | | ECG = electrocardiogram/electrocardiographic | | LAS40 = duration of low-amplitude signals <40 µV in the terminal filtered QRS complex | | LP = late potential | | RMS40 = root mean square voltage of the terminal 40 ms in the filtered QRS complex | | RVOT = right ventricular outflow tract | | RVOT-FW = free wall of the right ventricular outflow tract | | SAECG = signal-averaged electrocardiogram | | VF = ventricular fibrillation |
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